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Switching These Meds Can Save Your Liver

Switching These Meds Can Save Your Liver

Switching from efavirenz to raltegravir leads to significant improvements in fatty liver disease in people with HIV.

The long list of reasons to stop taking the HIV drug efavirenz (Brand name: Sustiva) is growing. A recent clinical study suggests that dropping efavirenz for replacement drugs can reduce the risk of liver disease.

The U.S. National Library of Medicine flags efavirenz as having an “uncommon but well established cause of clinically apparent acute liver injury.” It is commonly found in combination with other antiretroviral drugs as part of a HIV drug regimen. But switching from efavirenz to raltegravir as a replacement significantly improves chances against fatty liver disease, a new study suggests. The study, Changes in Liver Steatosis After Switching From Efavirenz to Raltegravir Among Human Immunodeficiency Virus, was published online on July 31 in Oxford's Clinical Infectious Diseases. Spanish researchers observed patients infected with HIV as well as patients co-infected with HIV and hepatitis C (HCV).

Thirty-nine individuals with a suppressed viral load and with hepatic steatosis were observed. Nineteen switched to raltegravir, and 20 continued to take efavirenz. After 48 weeks, patients who had switched to raltegravir showed less symptoms of hepatic steatosis. No patients involved had drug or alcohol problems.

“After 48 weeks, HIV-infected individuals switching efavirenz to raltegravir showed decreases in the degree of hepatic steatosis, as measured by controlled attenuation parameters, compared with those continuing with efavirenz,” researchers concluded. “In addition, the proportion of patients without significant hepatic steatosis after 48 weeks was greater for those who switched to raltegravir.” The participants' livers were assessed using a Fibroscan, which measures liver stiffness and the accumulation of fat.

It only takes 1-8 weeks for symptoms of liver hepatotoxicity to appear which could include a rash or a fever. Other less toxic alternatives to efavirenz are available. A separate study pointed to doravirine as a replacement for efavirenz, with less side effects. Patients who switched to doravine experienced significantly less neuropsychiatric events versus patients who remained on efavirenz after 48 weeks.

Efavirenz, according to science, can cause profound hallucinationssuicide, mood swings and cholesterol problems. The dizzying list of side effects sounds like a prescription drug infomercial. “The HIV antiretroviral drug efavirenz has LSD-like properties,” a study published in the U.S. National Library of Medicine admitted. Most patients that have taken efavirenz, like myself, experienced unwanted nighttime and daytime visions approximately every three days while on efavirenz. The paralyzing emotional effects are hard to describe. Despite the risks, the drug is quite popular worldwide.

Switching to raltegravir can reduce the risks. You are, however, paying for the non-toxic qualities of raltegravir. The monthly cost of efavirenz is $1,010 compared to the monthly cost of raltegravir which is $1,712.89. In the United States efavirenz is often sold individually as Sustiva and raltegravir is sold as Isentress. Raltegravir will surely grow in popularity as a less toxic alternative, despite efavirenz' popularity.

Efavirenz has been used frequently in the United States as one of the three drugs in the tablet Atripla, one of the most common once-a-day HIV regimens. It was initially applauded at being one of the best known drugs to pass the blood/brain barrier.

Mylan Pharmaceuticals just got the green light to launch generic version of Atripla containing efavirenz in Canada. Avonza, a very similar generic drug also containing efavirenz, was launched in India on August 8. Avonza is lower than half the price of “first-line” antiretrovirals. The company produces 4 billion antiretroviral tablets per year. In Costa Rica, efavirenz was so popular that Costa Rican authorities announced  on August 18. It is foolishly used recreationally and wasted in South Africa, where HIV drugs can be found anywhere relatively easy.

Modern drugs, of course, are an improvement from older generation drugs like AZT. But HIV patients have enough to worry about than to be concerned with daytime and nighttime hallucinations and the inability to think clearly. There are plenty of safer alternative drug regimens out there. Stribild and Genvoya, for instance, are efavirenz-free and potentially less risky drug regimens compared to Atripla. Many are afraid change the medicine that they already know works. All you have to do is ask about other drugs to your doctor, and chances are your out-of-pocket premium will stay at the same rate. Doctors will rarely inform you on their own about the latest drugs that are available.


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Benjamin M. Adams