Efavirenz (Sustiva, also in the combination pill  Atripla)  is one of the drugs recommended for people starting HIV treatment. The drug triggers a pool of side effects including dizziness, anxiety, sleep disorders and even depression in rare instances.

Side effects usually emerge during the first few weeks of being initiated on treatment, after a while they decrease and eventually fade away. For a selected few severe side effects overpower them into abandoning treatment.

The Spanish survey also points out that gradually increasing the dose doesn’€™t risk resistance or threaten patients’€™ chances of reaching an undetectable viral load.

The small study involved 114 participants – 60 out of these had their efavirenz dose gradually increased.  

This involved taking 200mg of the drug daily for the first six days, increasing it to 400mg the following seven days before switching to the full 600mg after the14th day.

The remaining 54 took a standardised dose of 600mg once-daily immediately when starting treatment with efavirenz.

By the time the first group switched to the standard dose they had been taking the drug for two full weeks.

Within the first week of treatment 55% of the patients experienced sleep disorders and other mental disorders. 66% of these were from the group initiated on the 600mg standard dose while only 47% of the ones who took a stepped dose reported side effects.  

In the same week 33% of patients taking the gradually increased dose reported dizziness compared to the 66% from the standardised group.  

During the second week similar proportions of both groups reported mental and sleep problems (49% vs. 58%) but the symptoms were less severe for those who were on a reduced dosage.

After four weeks of taking the treatment 52% of participants reported sleep disorders and 7% of patients discontinued their treatment because of the side effects.  

The severity of side effects including dizziness and sleep disorders was associated with levels of efavirenz in the blood.

An equal amount of those taking a gradually increased dose and those on a full dose had an undetectable viral load.

The authors concluded that the stepped dose of efavirenz over 2 weeks significantly reduces the incidence and severity of side effects while maintaining the same effectiveness as the standard programme.

For more on the study click here