Efavirenz (Sustiva) is a powerful anti-HIV drug that must be taken in combination with other antiretroviral drugs. It has been proven to reduce HIV-1 viral load to below 400 copies/ml within six months in 60 to 80% of people who have not previously taken any HIV treatments. Efavirenz is not active against HIV-2.

Efavirenz has been recommended as a component of first-line antiretroviral treatment since 2002 on the basis of studies showing superior outcomes for people treated with efavirenz-based combinations when compared to protease inhibitor-based treatment or treatment based on nevirapine.1 2 3 4 5 6 7 8

Recent studies have shown that the integrase inhibitor dolutegravir is more effective than efavirenz, and that the NNRTI rilpivirine is better tolerated (although less effective than efavirenz in people with high viral load, above 100,000 copies/ml).


  1. Staszewski S et al. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. N Engl J Med 341: 1865-1873, 1999
  2. Tashima K et al. Durable viral suppression on EFV-based HAART: 168 weeks of follow-up. 15th International AIDS Conference, Bangkok, abstract TuPeB4547, 2004
  3. Arribas JR et al. High effectiveness of efavirenz-based highly active antiretroviral therapy in HIV-1-infected patients with fewer than 100 CD4 cells/ul and opportunistic diseases: the EfaVIP study (efavirenz in very immunosuppressed patients). AIDS 16: 1554-1556, 2002
  4. Schafer R et al. Antiretroviral strategies in naive HIV+ subjects: comparison of 4-drug versus sequential 3-drug regimens (ACTG 384). 14th International AIDS Conference, Barcelona, abstract LbOr20B, 2002
  5. Robbins G et al. Antiretroviral strategies in naive HIV+ subjects: comparisons of sequential 3-drug regimens (ACTG 384). 14th International Conference on AIDS, Barcelona, abstract LbOr20A, 2002
  6. INITIO Trial Coordinating Committee et al. Virological and immunological outcomes at 3 years after starting antiretroviral therapy with regimens containing non-nucleoside reverse transcriptase inhibitors, protease inhibitor, or both in INITIO: open-label randomised trial. The Lancet 368: 287-298, 2006
  7. van Leth F et al. Comparison of first-line antiretroviral therapy with regimens including nevirapine, efavirenz, or both drugs, plus stavudine and lamivudine: a randomised open-label trial, the 2NN Study. The Lancet 363: 1253-1263, 2004
  8. Riddler SA et al. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med 358(20):2095-2106, 2008
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.