April 1, 2008
A study published in the journal AIDS found that ethnicity and quality of life measures affected how likely people were to experience failure on a regimen with Sustiva (efavirenz). The analysis from ACTG A5095 adds to a growing sense of unease about Sustiva, particularly in people of African descent.
ACTG A5095 compared two regimens -- Trizivir (zidovudine/AZT + lamivudine/3TC + abacavir) vs. Sustiva + Combivir (zidovudine + lamivudine) -- in people taking HIV drugs for the first time. Earlier analysis had found a higher rate of treatment failure in participants of African descent. The researchers tried to find out what factors may explain this.
The study looked at over 700 people, who had one or more adherence evaluations during the study. Overall, not adhering to the regimens after 12 weeks strongly predicted treatment failure. However, looking more closely, this was only true for participants of African descent but not for whites. The researchers also found a strong relationship between lower quality of life and risk of treatment failure. They found no relationship between quality of life and ethnicity.
Some research, along with many anecdotal reports, suggests that people of African descent may experience more severe side effects when taking Sustiva, compared to other ethnic groups. At least one study found that Africans might break down Sustiva more slowly than other ethnic groups. This might help explain the higher risk of side effects, as Sustiva could accumulate in a person's body, raising the risk of side effects.
Understanding the risk of side effects from HIV drugs is vitally important; even more so for widely used drugs like Sustiva -- which is part of the popular fixed-dose combination Atripla. Sustiva is a powerful and often effective HIV treatment. It is also well known to cause side effects, particularly neuro-psychological effects like vivid dreaming and depression. African Americans are disproportionally impacted by HIV/AIDS and tend to be under-represented in clinical studies of HIV drugs. Research like this may lead to better understanding and use of Sustiva.
This research does not suggest that people, including those of African descent, should stop taking Sustiva. It does point to the importance of good adherence and attention to quality of life. This is true no matter what combination of HIV drugs a person takes. It also highlights the need for more research on the affect of ethnicity on regimens with Sustiva.