Factors to consider: depression and CNS
- EFV is associated with:1
- Significantly increased levels of stress
- Trend towards increased total depression scores
- Trend towards increased levels of anxiety
- Incidence of CNS effects higher in those prior history of psychiatric disorders (57% vs. 47%)2
- Those without prior history of psychiatric disorders tend to tolerate NSS effects better2
- Important to recognise & treat psychiatric disorders before starting EFV therapy2
1. Adapted from: Rihs TA et al. HIV Med 2006;7:544–548 2. Cohen CJ & Kessler HA. http://www.medscape.com/viewprogram/2859_pnt
Factors to consider: resistance with first-generation NNRTIs
- Major disadvantages
- single mutation can confer resistance1
- broad class-wide cross-resistance2
- prevalence of NNRTI-resistant viral strains in treatment-naïve patients1–4
- Patients virologically failing an initial NNRTI regimen
- lose utility of all approved NNRTIs
- more likely to develop resistance than with PI-based regimen5
- may transmit resistant virus to others2
- Other fully active ARVs needed to protect from development of resistance
1. Weinstock HS, et al. J Infect Dis 2004;189:2174-80. 2. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents, 2006: http://AIDSinfo.nih.gov. 3. Wensing AM, et al. J Infect Dis 2005;192:958-66. 4. Novak RM, et al. Clin Infect Dis 2005;40:468-74.
5. Von Wyl V, et al. Arch Intern Med 2007;167:1782-90.
Factors to consider: genetic barrierto the development of resistance
1. Antinori A, et al. AIDS Res Hum Retroviruses 2002;18:835-8.
2. Lecossier D, et al. J Acquir Immune Defic Syndr 2005;38:37-42.
3. Vingerhoets J, et al. IV EHDRW, 2006.
4. Bertoli A, et al. IV EHDRW, 2006.
5. de Mendoza C, et al. HIV Clin Trials 2006;7:163-71.