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    New HIV Drug Leads the Pack


    "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 year."

    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.

    Vital Information:

    • Sustiva, in combination with other drugs, is a potent anti-HIV treatment.
    • 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 combinations.
    • 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 becoming pregnant.
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