Question

What drug can I switch to instead of efavirenz?

14 March 2008. Related: All topics, Changing treatment, Side effects, Starting treatment.

I have been taking efavirenz for a month but am going to switch because the CNS side effects are too much.

My CD4 is quite high – around 360 – so my doctor said I should avoid nevirapine. This suggests I should switch to a PI. Any ideas on which is the best way to go?

I was taking Kivexa with efavirenz. thanks

Answer

Answer: Simon Collins

Hi

It sounds like efavirenz is not right for you and you have given it a good try. In this case it is easy and best to switch to another drug.

The guidelines for nevirapine are to not start treatment if your CD4 count is over 250 for women and over 350 for men. If you are a woman, then your doctor is giving you good advice. This would still be ok as an option though if you are a man (I can’t tell from your questions).

Because efavirenz and Kivexa (abacavir+3TC) are once-daily drugs, one option you have is to use a PI called atazanavir (Reyataz) which is dosed at 300mg once-daily plus a boosting dose of 100mg ritonavir (Norvir).

This would mean you are still on a once-daily combination, and if this will help with adherence (taking all your pills on time) or with your quality of life, you should discuss this with your doctor.

Although atazanavir/r is not strictly recommended for first-time treatment, is is widely prescribed this way in the US and Europe, and a recent study showed comparable results to lopinavir/r (Kaletra).

Other boosted PI combinations are twice-daily, and include lopinavir/r (Kaletra), fosamprenavir/r (Telzir) and saquinavir/r (Invirase/r).