New HIV Drug Leads the Pack
WebMD News Archive
"Efavirenz in adults has surpassed the current standard of care with
protease inhibitors by 50% and the current standard in children by 100%,"
Manion says. "Anyone who has responded through one year succeeded through
the second year. There are basically no [treatment] failures through the second
Jeffrey Lennox, MD, agrees. "I've seen the study results presented,"
he tells WebMD. "I think people feel the study was well done." He and
his colleagues already are using Sustiva as a first-line therapy for
appropriate patients. "Generally, efavirenz is a good choice for most
patients, but you have to individualize treatment based on their own needs and
treatment history," says Lennox, who is the medical director of the Emory
University infectious disease program at Atlanta's Grady Memorial Hospital.
"We've started quite a few of our children on efavirenz, and one of the
main reasons is it comes in a liquid formulation that children find tolerable.
[The protease inhibitor] ritonavir has a liquid formulation that's very potent,
but you can't get kids to take it."
Starr noted that the pediatric study used Sustiva formulated in capsules, as
the cake icing-flavored liquid formulation became available only after the
study began. However, Starr said that preliminary results from a new study
using the liquid show no difference in efficacy but a much lower incidence of
rash, a side effect of the drug in 30% of the study children.
In addition to rash, which generally resolves after two weeks of continued
dosing, Sustiva causes central nervous system (CNS) symptoms in more than half
of patients. These symptoms can include dizziness, trouble sleeping,
drowsiness, trouble concentrating, or vivid dreams and nightmares, but they
usually resolve after two to four weeks. However, the drug is not recommended
for psychotic patients, a few of whom have had very severe symptoms far
different than the usual CNS effects. Also, women taking Sustiva must avoid
pregnancy, as the drug causes birth defects in animals. The drug can be taken
with or without food but not with a high-fat meal.
- Sustiva, in combination with other drugs, is a potent anti-HIV
- The combination of Sustiva and Viracept (a protease inhibitor) works very
well even in young children, and is easier to take than other anti-HIV drug
- While less toxic than some HIV drugs for some people, Sustiva has side
effects. It must never be taken by pregnant women or women who are planning on