Hi all,
Just wanted to clarify a few points from this thread following consultation with a specialist in this field:
• Efavirenz contains amphetamines:
This is not the case, it has a completely different chemical structure, and bears no chemical similarity to amphetamine or methamphetamine.
• Efavirenz contains "a huge amount of AZT ":
This is not the case, Stocrin® tablets contain no AZT, but rather 600mg of efavirenz plus the inactive ingredients sodium lauryl sulfate, lactose, magnesium stearate, and sodium starch glycollate.
• Efavirenz is an "ancient treatment" and "an old style of HAART" and that it "an ancient treatment as it contains a high percentage of AZT it is this that causes lipo"
This is incorrect: Efavirenz was first introduced into the PBS in 1999, it is a safe and efficacious HIV drug in good standing throughout the world.
It is listed as one of two drugs (Nevirapine or Efavirenz) in the non-nucleoside reverse transcriptase inhibitor (NNRTI) class to effectively suppress HIV-1 viral replication.
See: World Health Organisation Antiretroviral therapy for HIV infection in adults and adolescents 2006 guidelines
http://www.who.int/hiv/pub/guideline...guidelines.pdf, and
the European guidelines: European AIDS Clinical Society (EACS) Guidelines for the Clinical Management and Treatment of HIV Infected Adults in Europe
http://www.europeanaidsclinicalsociety.org/guidelinespdf/1_Treatment_of_HIV_Infected_Adults.pdf
It does cause some disturbances to the way sugars and fats are processed in the body, but it does not cause lipodystrophy.
• Efavirenz tablets "are given to nearly everyone as a first regime, as they are the cheapest to produce for the Australian Gov.".
This is incorrect:
Firstly the recommended retail prices of Nevirapine and Efavirenz as listed in the PBS are: Nevirapine $271.58, and Efavirenz $452.64 per 30-day supply. Nevirapine is cheaper for the government, but can't be prescribed for some males who have a moderate CD4+ count (>400 cells/mm3) because of concerns about its liver toxicity.
Secondly, that a range of first-line HIV drugs are recommended and actually used in Australia (not just one). Some doctors prefer NNRTI regimes others prefer protease inhibitor (PI) regimes. The 'backbone' is normally two nucleoside (or nucleotide) reverse transcriptase inhibitors (usually Truvada® or Kivexa®) plus either an NNRTI (Efavirenz or Nevirapine) or a PI boosted with Ritonavir.
See: Australasian Society for HIV Medicine Guidelines for the use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. November 3, 2008. Incorporating commentary to adapt the guidelines to the Australian setting. Page 30 onwards
http://www.ashm.org.au/images/publications/guidelines/dhhsadult_04_03_09%20-%20final.pdf
• "The cost of Truvada is 8 times that of Efavirenz, generally the reason they like to keep you off them if they can"
Incorrect, Truvada® has a recommended retail price of $765.10, this is about 1.7 more costly than the same 30-day supply of Efavirenz.
In addition Efavirenz and Truvada® are not mutually excluded: In fact they are often prescribed together in combination.
The argument that clinicians prescribe Efavirenz instead of Truvada® because it is cheaper is incorrect: they are in different drug classes.
The ACON website has a news item about the new drug in the NNRTI class which has recently been listed in the PBS.
http://www.acon.org.au/hiv/news/etravirine
Etravirine is a possible substitute drug for people who find that they cannot tolerate Efavirenz.
If people have intractable problems in managing the side effects of Efavirenz they should request their HIV doctor to consider switching them to another NNRTI (Nevirapine or Etravirine) or switching them to a protease inhibitor containing regime: for example Atazanavir (Reyataz®) or Darunavir (Prezista®) or Kaletra®.
The reality is that all these HIV drugs have side effects, however, after a period of settling into a new treatment most people can manage them. Consider it preferable to have to cope with side effects than slide into a compromised immune system and the risk of opportunistic infections, or other AIDS-defining conditions. There is increasing medical evidence that untreated HIV, even with moderate CD4+ counts, exposes people to a risk of early non-AIDS medical conditions such as cancers, cardio-vascular disease and neurological damage.
Help is available from both local AIDS councils and People With HIV organisations on managing side effects and adjusting to new treatments.
As in all these things, people should feel comfortable speaking with their HIV doctors: all S100 prescribers have to attended a prescriber's course on HIV medicine and clinical care, and be accredited by the Australasian Society for HIV Medicine. Most are highly skilled and well informed about advances in HIV medicine.
We hope that this information is useful.