Efavirenz is one of the most powerful, effective and widely used
of the antiretroviral drugs that are used to fight HIV. It belongs
to a class of drugs called non-nucleoside reverse transcriptease
inhibitors (NNRTI). As with all anti-HIV drugs, the list of
possible (but usually mild and tolerable) side-effects is quite
long; but efavirenz, in particular, is the subject of much heated
debate that leaves patients sharply divided between those who (like
me) love it and those who simply find it intolerable and therefore
loathe it. The reason that efavirenz stimulates such hot debate is
that it is one of the few anti-HIV drugs that is able to cross the
blood-brain barrier. Although most people see this as a positive
benefit, the fact that it does cross this barrier also leaves a
minority of patients susceptible to a range of distressing
psychiatric / central nervous system (CNS) symptoms (including
anxiety, euphoria, depression, the feeling that you are "going
mad", sleep disturbances and vivid dream / nightmares). Whilst
nearly all patients will experience a mild form of some of these
side-effects (usually sleep disturbance and vivid dreams), they
usually fade after a few days or weeks. Before starting treatment
with efavirenz, your doctor should give you specific information
about all the possible side effects and what to look out for.
Ultimately less 15% of patients are unable to adjust to efavirenz
and will stop taking it because of the general effect on their
quality of life.
