Truvada/ Sustiva vs. Truvada/ Viramune

[Joel90069]

Does anyone know if there is an effectiveness advantage of going with Truvada and Sustiva vs. taking Truvada and Viramune? Why do physicians opt for Sustiva first?

[newt]

Hello Joel

Until recently, many studies were done using Sustiva, but not Viramune, as first-line therapy, which secured its status as the preferred starter NNRTI.  However, Viramune is an effective drug.  This was confirmed by the NEFA study, which found (in which PI treated patients with viral loads under 200) no difference in effectiveness or discontinuations from side effects between Sustiva and Viramune, and the 2NN study, which found, broadly speaking, Sustiva 1 x day, Viramune 1 x day and Viramune 2 x day to be equally effective (2/3rds of people achieving undetectable viral loads).

UK and US guidelines recommended Sustiva as first choice and Viramune as an alternative. This is largely because of the small risk of serious reactions against Viramune. Plus Viramune is licensed as a 2 x day drug, to be strict about it while Sustiva is licensed for use 1 x day (1 x day being apparently easier for people taking the tabs....). 

Both drugs have some similar side effects. This includes risk of rash and liver toxicity, which can be serious. Careful monitoring should check for this. Sustiva is well known for its head effects (dreams, dizziness, anxiety), which Nevirapine doesn't have (except in a very, very few cases).

In practice, both drugs are used widely, maybe 60% of people using NNRTIs on Sustiva and 40% on Viramune in the UK.

- matt

[newt]

I see from your other post that you's gone the Sustiva route.  Good luck, the side effects often lessen with time, you'll know sooner or later if it;s for you long-term.  Usually a switch to Viramune is pretty straightforward, but do note that in men with a CD4 count of 400+ the chance of a rash/bad liver reaction is higher, and your CD4 count's edging that way now, so if a change is on the cards a PI may be a better choice.

- matt

[Joel90069]

Thanks for the comprehensive response! I'm leaning toward switching. I'm moody, isolating and having a problem concentrating. Eventually it's going to have an effect on my work performance.

[J.R.E.]

Hello Joel,

 I was started on Viramune ( first time therapy ) back in October of 2003. Still on it. And of course, I don't have any of the vivid dreams or mood swings associated with Sustiva. As far as the Truvada, I am on the Viread component of that. Never done Emtriva.

I also went through the break in period with Viramune, very well, with no problems. I often wonder if my doctor had started me on viramune, due to the fact that I was working full time.



The Best---------Ray

[Dboy]

I am on the sustiva and truvada regime and went undetectable quickly so this combo is very effective.  My triclyserides have gone up rather high and everything that you have heard about the sustiva head trips are spot on.  This is my third month and the effects have moderated but my doctor is worried about the restless sleep, fatigue and focusing problems that are still with me.  I'm thinking now I should have gone with the viramune instead of sustiva.  Taking the pills just one a day is good but I also take various vitamins and supplements and an allergy pill so one more pill would not be a big thing for me.  Sustiva was first out and has a good track record so that is why it is listed ahead of the viramune.  And viramune does have the allergic reaction potential.
Just my thoughts and experiences.
David

[Joel90069]

Dboy, that's exactly how I feel with Sustiva. Even though I'm undetectable I'm going to take the risk and make the change. Thanks for your input.