Re: Efavirenz based REGIMEN

[Guest guest]

Dear All:

I think it is important to bring to the attention some latest research from the

Retrovirus conference.

Efavirenz, when combined with other NRTI'ss is an excellent drug to control HIV

infection. As for other combination there may be a need to stop HAART for any

number of reasons- side effects, interactions...etc.

There was paper which showed that once the efavirenz based combo is stopped

efavirenz levels continue to be present at theraputic doses for as long as two

weeks (especially so in people of african origin).

How does this impact clinical practice?

Research has shown that NNRTI mutation can develop even with very few doses of

NNRTI [(some say just one dose is enough), (e.g as in NEVIRAPINE used for

vertical tranmsission prevention).

So, when a NNRTI based cocktail is stopped, levels of NNRTI (both efavirenz and

nevirapine) are high enough to elicit the virus to mutate. Based on this there

have been suggestions that when a NNRTI based combination has to be stopped for

whatever reason, it may be advisable to continue the other two drugs in the

cocktail.

For eg AZT and Epivr [if they were part of the combination of AZT, EPIVIR and

NNRI (efavirenz or combivir)] to be continued for up to 1-2 weeks after the

NNRTI is stopped.

By this, the risk of NNRTI staying alone in the blood for two weeks and thus

exposing it to chance of developing resistance can be prevented.

This is particularly important in the developing world where NNRTI's are the

mainstay of HIV treatment.

Vijayabhaskar Reddy Kandula

AIDS Healthcare Foundation, N La Cienega Blvd, St 200

Beverly Hills CA 90211. Ph: 310 657 9353 ext 224

e-mail:<emailreddy@...>