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Plasma efavirenz levels are known to vary widely, and high concentrations have been linked to the drug's adverse effects on the central nervous system. Some investigators have proposed that dose reduction might alleviate these side effects, but the safety of this approach in terms of antiviral efficacy has not been clear.
Using a Dutch national HIV registry, researchers identified patients who had plasma efavirenz levels evaluated within 48 weeks after starting treatment. A total of 180 patients had levels above the upper therapeutic limit of 4.0 µg/mL. Of these, 131 continued to take a standard 600-mg daily dose of the drug, 47 had the dose reduced to 400 mg daily, and 2 had the dose reduced even further. Plasma levels were reevaluated afte…