Efavirenz: practicalities, considerations and new issues.

Concerns about the long-term safety issues with protease inhibitors (PIs) and recent reports of non-PI-containing regimens demonstrating potent and durable suppression of viral replication have brought into question the role of PI therapy. However, a number of issues surrounding PI-sparing regimens, such as the durability of the antiretroviral effect, the virologic benefits in sanctuary sites, and the extent of changes in immune function, need to be clarified. The role of efavirenz in both PI-sparing first-line and salvage regimens is currently being investigated. Evidence to date has indicated that efavirenz has a highly potent and durable antiviral activity in such regimens. Efavirenz is well tolerated with adverse events generally being mild in intensity and infrequently prompting discontinuation.