• Use of efavirenz in a low-income population (Poster, WePeB4138)
  Authored by D. Parrish, J. Godbey
• Evaluation of novel combination of abacavir (ABC), lamivudine (3TC) and efavirenz (EFV) (Poster, WePeB4139)
  Authored by J. Godbey, D. Parrish

As several studies have shown the effectiveness of Sustiva (efavirenz), there has been an emphasis in helping us understand who can and cannot tolerate this medication. This is particularly true given the potential for changes in mood and sleep patterns in the first few days to weeks of its use. Therefore, this study was done to report on the safety of using efavirenz in those with a history of either a mental health diagnosis such as depression, or a history of substance use, or both.

The researchers gave 21 patients a regimen containing efavirenz, and used a unique approach of initially giving d4T, 3TC, and efavirenz for one month, and then substituting abacavir instead of the d4T. This was done to avoid overlapping the start dates of both efavirenz and abacavir. There are potentially overlapping side effects (especially a rash), and it was considered easier to separate starting these drugs so as to make it clearer which drug was likely causing the rash if it happened. Overall, about 71% had a history of some mental health condition, while 43% had both a history of mental health disorders and a history of substance use. They reported only one discontinuation due to intolerance (fatigue), despite the occurrence of the typical Sustiva side effects noted in the first month, such as vivid dreams or dizziness. While two people did have worsening mood which led them to substitute nevirapine for efavirenz in this study, the patients did not demonstrate improvement on the new regimen. This was thought to suggest that efavirenz was unlikely to be the cause of the mental health condition but rather the mental health problem itself was worse at that time.

In terms of the viral load response, it is noted that while all patients were non-nucleoside-naive, some had pretreatment with other antivirals, including 3TC, one of the medications in this combination. Despite this, they reported that out of 17 patients, 53% achieved a viral load below 50 copies, and 82% had a viral load below 400 copies.

The researchers reported that the extensive counseling that they did before treating their patients may have been of help in maintaining their patients on this otherwise simple regimen. This message can be of use in considering treatment options, even for those with significant other medical concerns.