Merck Sharp & Dohme and DuPont Pharmaceuticals' non-nucleoside reversetranscriptase inhibitor Sustiva (efavirenz), given as part of a combination antiretroviral regimen with GlaxoSmithKline's reverse transcriptase inhibitors lamivudine and zidovudine, provides greater and more durable viral suppression through three years of follow-up than combination therapy using a protease inhibitor.
The new findings were presented at the International AIDS Society Conference on HIV Pathogenesis and Treatment (see story alongside) and came from long-term follow-up in a pivotal trial (006) which was completed in 1997 and served as part of the clinical evidence for the regulatory approval of Sustiva. At the end of three months, 52% of patients receiving Sustiva-based treatment had HIV levels below the limit of detection (<50 copies/ml), compared to 30% of patients receiving PI-based therapy.
The NNRTI was very well-tolerated, with a low incidence of late-onset adverse events. Sustiva has been associated with side effects, particularly in the first few weeks of treatment (in common with most antiretroviral drugs), but the new data "suggest that patients who work through the early events and have successful outcomes may not experience events later on with this treatment," according to Karen Tashima of Brown University in the USA, one of the investigators in the trial.
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