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Hiv Antiviral Drugs
C O N T E N T S:
KEY TOPICS
Four classes of antiviral drugs are currently available against HIV currently.(More…)
Drug combinations are given in order to both increase efficacy of viral suppression, and to decrease the likelihood that the HIV genome can mutate to develop resistance to therapy (e.g. the chances of HIV mutating so that it can resist the effects of drugs working by three different…
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I've been doing well on nevirapine for almost 3 years. Now my doc wants me to switch to efavifenz. I asked her why and she said that with time nev. will be toxic to my liver and resistance is more likely to occur than with efav. Is she right?
No, not exactly. While it’s true that nevirapine has more liver toxicity than efavirenz, the toxicity occurs in the first months of therapy. If you’ve been on it for for almost 3 years, you’re out of danger.Â
As for resistance, it’s also true that failure of nevirapine can lead to broader cross-resistance within the NNRTI class than failure of efavirenz, but resistance only happens if you fail.  You’ve been taking it for 3 years without failure, so resistance doesn’t sound like an issue.
I’m not telling you not to switch. Efavirenz is a better drug to start with than nevirapine, but you’re not starting therapy. You’ll probably also have to deal with some efavirenz side effects, at least in the beginning.
I heard there was a new drug coming out "doravirine" is there any time frame for when it will be released and when the combination with tenofovir DF + lamivudine will come out? Thanks Doctor Joel.
Doravirine is a new NNRTI (non-nucleoside reverse transcriptase inhibitor) from Merck that has potential advantages over the other drugs in its class. It doesn’t cause the CNS side effects that we see with efavirenz (Sustiva, Atripla); it doesn’t have the food or gastric acid requirements of rilpivirine (Edurant, Complera); and it may have better activity against NNRTI-resistant virus than etravirine (Intelence).  It’s being studied in a coformulation with lamivudine and tenofovir, both of which may be generic by the time it’s approved, so there may be price advantages.
Phase II data were presented last week at CROI. Doravirine performed as well as efavirenz in that study with fewer CNS side effects, though the results were not as impressive as what we generally see in other clinical trials these days. Phase III trials are in progress, but it’s too early for me to predict when it might be approved. Definitely not this year.
HIV Treatment Showdown: Doravirine vs. Sustiva New studies show Merck’s new NNRTI doravirine (MK-1439) is completely comparable to Sustiva in terms of efficacy, but it has fewer central nervous system side effects. Something to consider when going on — or changing up — you HIV treatment.
