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Sustiva... Johns Hopkins says it attacks our brain cells
Sep 30, 2012

I've been taking sustiva since 2004 and after reading the Johns Hopkins study about the killing of brain cells by the sustiva component, it is time to change. I've been spoiled by taking one pill at nite along with cauduet and tenormin and an aspirin. I can take any med avail to us. What would you suggest I take keeping in mind that I have taken my meds at nite for many many years and prefer to keep it that way.

Response from Dr. Young

Hello and thanks for bringing this important finding to our readers attention.

The report from the group at Johns Hopkins University has recently been published, and though I have not had a chance to review in detail, raises some very important and interesting questions about the possible long-term toxicity of one of our most widely prescribed drugs.

I think that it would be premature at this point to stop using efavirenz on the basis of this study which merely looked at the presence of an efavirenz metabolic byproduct in spinal fluid. There's plenty of ground for additional clinical research to see if efavirenz metabolite levels correlates with neurocognitive disease. It's also relevant to be mindful that even if this turns out to be the case, that treating HIV is still better than not.

Until that time (and even before the release of these data), it's important to recognize the potential of cognitive problems in all people living with HIV. Indeed, many guidelines recommend the use of a screening tool, such as the International HIV Dementia Score to see who needs to have more detailed testing (including brain scans, neurocognitive testing and spinal taps). For people who do have confirmed problems with cognitive function, the jury is out on what is the best strategy, but several reputable groups have suggested testing for virus (and drug resistance) in the spinal fluid, and to switch to antiretroviral medications that cross into the brain better (the so-called "CNS Pentetration Effectiveness" or CPE). While efavirenz does cross into the brain acceptably well, and we might extend these recommendations to consider if efavirenz can be replaced with an alternative medication for those select individuals.

Stay tuned, I'm sure that there will be much more on this topic. BY



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