EFAVIRENZ IN THE MANAGEMENT OF HIV INFECTION

Abstract

SUMMARYEfavirenz, which is likely to be licensed in the UK and throughout Europe shortly, represents a major advance in the treatment of HIV infection. It belongs to the non‐nucleoside reverse transcriptase (NNRTI) class of drugs and, as such, it should only be prescribed with other potent therapies to avoid the development of resistance. However, in the pivotal head‐to‐head comparison of efavirenz with lamivudine and zidovudine, treatment over a 24‐week period proved superior to treatment with a standard regimen containing indinavir. The results from prolonged follow‐up of this study are eagerly awaited but it is clear that a combination of efavirenz with nucleoside analogues provides a potent proteinase inhibitor‐sparing regimen which may have less toxicity. Additional data also indicate that the combination of a proteinase inhibitor (indinavir) with efavirenz provides an extremely potent regimen which is well tolerated and produces complete inhibition of plasma HIV viraemia over prolonged periods of follow‐up. In common with many other currently available potent anti‐HIV therapies, the optimum use of this drug is being determined by ongoing clinical studies but it is clear that ease of administration (once‐daily), freedom from serious side‐effects and potency when used in combination are likely to represent a very considerable advance in the management of HIV infection.