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What makes it
Sep 26, 2003

Dear Dr.,

What, in particular, makes Sustiva so effective? I remember it heralded as a breakthrough drug, is this accurate and how long until we see more like it?

Thanks

GH

Response from Dr. Wohl

There may be several factors that account for the success of the non-nucloside reverse transcriptase inhibitor Sustiva (efavirenz). First, the drug has a relatively long half life, meaning it maintains in the body for a long period of time. This is an asset especially when doses are missed or taken late. Second, the drug seems to have access to many different compartments in teh body including the central nervous system where we know HIV can lurk. Third, as a consequence of its longer half life, it is a true once a day drug and this may positively impact adherence to the drug. Lastly, it is well tolerated.

The differences between Viramune (nevirapine) and Sustiva are subject to debate and study. While previous data seemed to indicate that Sustiva was the more potent of the pair, more recent research suggests the differences may not be as great as we thought.

There is a need for new drugs in this class that can be used after Sustiva or Viramune failure. There are some promising candidates in development but it will probably be a few more years until these get to market.

DW



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