Sustiva, a non-nucleoside reverse transcriptase inhibitor (NNRTI), was an important part of initial combination antiretroviral therapy for many years, especially as a component of the single-tablet regimen Sustiva-tenofovir disoproxil fumarate (DF)-emtricitabine. In recent years, Sustiva has fallen out of favor and has been replaced by newer agents that are more tolerable. The primary concern regarding Sustiva is the risk of neuropsychiatric adverse effects, including depression and suicidality. In adddition, Sustiva frequently causes sleep disturbances, vivid dreams, grogginess, and disorientation. Some studies have also shown that Sustiva may cause unfavorable changes in lipid parameters and reductions in vitamin D levels. For these reasons, in the United States Sustiva is no longer designated as a recommended option for initial antiretroviral therapy and most clinicians have a low threshold to switch from Sustiva to a newer agent if the patient is experiencing any intolerance. Concerns have been raised regarding potential teratogenicity related to the use of Sustiva in pregnancy, based on early reports of neural tube defects, though that risk has not been confirmed in larger trials and systematic reviews. Sustiva has a relatively low barrier to resistance, but the mutations that commonly occur carry less cross-resistance with other NNRTI’s as compared to the typical rilpivirine mutations. The Sustiva combination tablet includes tenofovir DF, as opposed to tenofovir alafenamide, which for many individuals may also be an indication to update it to more modern antiretroviral options.
Other names for this medication:
Efavirenz,
Adiva,
Aviranz,
Efamat,
Efavir,
Efcure,
Efferven,
Estiva,
Stocrin,
Sustiva,
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Orvagil,
Sefdin,
Omepren,
Actinex,
Neuril,
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Nevotek,
Nislev,
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