Efavirenz - Still first-line king?

Background: Efavirenz is a potent, safe and tolerable non-nucleoside reverse transcriptase inhibitor (NNRTI) recommended as initial therapy. Recently, several new antiretroviral drugs, including second generation NNRTIs, protease-inhibitors, an integrase-inhibitor and a CCR5 inhibitor, have become or will be shortly available. Objective: This article will review relevant efficacy and safety data of efavirenz compared to these novel agents or certain common alternate drugs currently used as initial therapy in treatment-naive patients. Methods: Published articles and conference presentations pertaining to efavirenz and/or the newer antiretroviral agents were evaluated. Results/conclusions: Efavirenz will continue to be preferred initial therapy for now. if longer-term studies of integrase inhibitors and second-generation NNRTIs confirm initial findings, they will eventually supplant efavirenz as preferred first-line agents.