Many people with HIV beginning treatments in Australia start on Atripla (a combination of efavirenz, tenofovir and emtrictabine).
While this combination is successful in reducing viral loads and improving CD 4 counts in most patients, some people have difficulty tolerating the side-effects of efavirenz.
These can include dizziness, abnormal dreams and nightmares and more rarely, a rash. These side-effects usually only last for several weeks and people adjust to the drug.
For those people who continue to experience these side-effects, the only alternative NNRTI to use has been Viramune (nevirapine).
Atripla has been a preferred option for starting treatment because it contains the most effective NNRTI to date (efavirenz). A new alternative, Complera has been approved in the US and is likely to be approved in Australia soon. Complera contains rilpivirine, a new NNRTI, which has been shown to be a valid and safe alternative to efavirenz in treatment-naïve patients. It also contains tenofovir and emtrictabine.
The US regulators say efavirenz remains their preferred option for commencing treatment as people with a high viral load (above 100,000 copies) are more likely to experience virological failure and resistanceHIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant. to the treatment on rilpivirine. However, rilpivirine is more easily tolerated than efavirenz and has fewer central nervous system problems.