Treatment Review; Double Issue #26 & #27 November 1997

Sustiva was formerly known as DMP 266 and now also has the generic name efavirenz, as well as this new brand name. Sustiva is an anti-HIV drug in the class known as non-nucleoside reverse transcriptase inhibitors or NNRTIs. Other drugs in this class are nevirapine (Viramune) and delavirdine (Rescriptor).

Unlike the other NNRTIs, Sustiva doesn't seem to cause a rash very often, and there haven't been any cases of the allergic reaction known as Stevens-Johnson Syndrome sometimes seen with other NNRTIs. The main side effects of Sustiva reported so far are light headedness, sinusitis, upper respiratory tract infection and diarrhea. The current dose is 600 mg taken once a day at bedtime. At the moment, researchers think that Sustiva in combination with other anti-HIV drugs may have some effect against HIV that's become resistant to the other NNRTIs.

An expanded access program for Sustiva opened on October 1. The program is for people with under 50 T4 cells whose current therapy isn't working or who have few options due to side effects. You don't necessarily have to have tried a protease inhibitor to qualify for this program. Enrollment is through your doctor. You or your doctor can call (800) 998-6854 for more information.

Adefovir Dipivoxil Expanded Access

Adefovir dipivoxil (also known as bis-POM PMEA, the new trade name is Preveon) is the first of a new class of anti-HIV drugs called nucleotide analogs. Nucleotide analogs work against HIV's reverse transcriptase enzyme like the nucleoside analog drugs AZT, ddI, ddC, d4T and 3TC. An important difference is that the nucleoside analogs have to go through some complicated chemical processing inside cells in the body in order to work against HIV. Nucleotide analogs like adefovir don't go through the same process and this seems make it harder for HIV to get resistant to the drug.

The strength of the anti-HIV effect of adefovir seems to be a little less than NRTI drugs, but the effect seems to last longer due to the lack of resistance. In one study there was little sign of HIV resistance to adefovir even after a year. Adefovir has also been found to work against many different types of herpesviruses and also hepatitis B. The main side effects seen so far have been nausea, diarrhea and elevated liver function tests. The drug is one pill, taken once a day.

As this issue of Treatment Review went to press, the manufacturer of this drug is reported to be preparing an expanded access program for people running out of treatment options with available anti-HIV drugs. The program will probably be small and limited to people with under 50 T4 cells and viral loads over 30,000. For more information call GILEAD Sciences at (800) GILEAD-5 (445-3235).

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