Reducing the side-effects of efavirenz

Efavirenz (Sustiva, also in the combination pill Atripla ) is a powerful anti-HIV drug that is taken just once daily.

It is one of the drugs recommended for people starting HIV treatment for the first time.

The main side-effects caused by efavirenz are dizziness, feeling vague or ‘spaced-out’, vivid dreams and other sleep problems, and - more rarely - depression.

These side-effects tend to happen in the first couple of weeks after a person starts treatment with the drug and then lessen or go away completely. Most people are able to tolerate them, but a small number have to stop efavirenz because the side-effects are so severe.

Spanish doctors have found that gradually increasing the dose of efavirenz that a person takes during the first two weeks of treatment with the drug reduces both the frequency and severity of these side-effects.

They also found that it was safe to do this and that people gradually increasing, or ‘stepping’ their doses of efavirenz, didn’t risk resistance or reduce their chance of getting an undetectable viral load.

Their research involved 60 patients who stepped their doses of efavirenz, and 54 people who took the standard 600mg once-daily dose as soon as they started treatment with the drug. The patients taking stepped doses took a 200mg daily dose for the first six days, increasing this to 400mg for the following seven doses, before switching to the full 600mg once they’d been taking the drug for two weeks.

The research also showed that the occurrence and severity of side-effects such as dizziness and sleep problems were related to the amount of efavirenz in the blood.

Equal proportions of patients taking stepped and full-dose efavirenz had an undetectable viral load every time this was measured during the study.

If you are experiencing, or are worried about efavirenz side-effects then you should speak to your doctor. You should never experiment with reducing your dose of this or any other drug without first speaking to your doctor. It's also important to note that the possible implications of this study only apply to people starting treatment with the drug. They do not necessarily apply to people who have longer-term mood and sleep disturbances caused by efavirenz.

For more information on starting treatment, as well as possible side-effects, you may find our information booklets useful. They are available free to people with HIV in the UK, as well as on our website.

HIV, HIV treatment and hardening of the arteries

Cardiovascular diseases such as heart attack and stroke are important causes of illness and death in people with HIV.

It’s now known that HIV itself increases the risk of such illness and that taking HIV treatment can reduce this risk. This is one of the reasons why it’s recommended to start taking anti-HIV drugs when your CD4 cell count is around 350 rather than waiting until later.

However, some anti-HIV drugs can also cause side-effects that increase the risk of cardiovascular disease.

People with HIV are at greater risk than the general population of developing hardening of the arteries, and Greek researchers wanted to see whether HIV itself or treatment with anti-HIV drugs was causing this.

They therefore measured the health of the arteries in 56 HIV-positive patients, including some who were taking HIV treatment and some who had not yet started antiretroviral drugs. They compared the results of these measurements with those obtained from the same tests performed on people recently diagnosed with high blood pressure – a traditional risk factor for hardening of the arteries. A ‘control’ group of healthy patients also had the same tests.

The results showed that people with HIV were more likely to have hardening of the arteries than the healthy HIV-negative controls, but had less hardening than those recently diagnosed with high blood pressure. 

Patients taking HIV treatment had more evidence of hardening of the arteries than HIV-positive patients not taking antiretroviral drugs.

People taking anti-HIV drugs were also more likely to have increased blood fats and blood pressure – traditional risk factors for hardening of the arteries.

HIV and sexual health

Good sexual health is important to everyone, but is especially so for people with HIV.

Not only can untreated sexually transmitted infections cause unpleasant symptoms, but it’s also known that they can increase viral load in sexual fluids, meaning that a person with HIV can be more infectious to their sexual partners.

There are currently epidemics of the sexually transmitted infections syphilis and LGV in the UK. Many of the people diagnosed with these infections have been HIV-positive gay men.

Now new figures have shown that a third of all cases of syphilis in the UK since 1997 have involved HIV-positive gay men. These figures also revealed that 75% of all cases of LGV have been diagnosed in gay men with HIV.

It’s recommended that people with HIV who are sexually active should have regular sexual health check-ups so that these and other infections can be promptly diagnosed and treated.