Sustiva is a brand name for efavirenz, a medicine used to treat HIV infection. It doesn’t cure HIV, but it helps control the virus so your body can fight it better. People who take Sustiva as part of their HIV treatment plan often see their viral load drop to undetectable levels, which means they can live longer, healthier lives and greatly reduce the risk of passing the virus to others.
How Sustiva Works in the Body
Sustiva belongs to a class of drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs). HIV needs an enzyme called reverse transcriptase to copy its genetic material and make more virus particles. Sustiva blocks this enzyme by sticking to it and changing its shape. When reverse transcriptase can’t work, the virus can’t multiply.
This makes Sustiva a key part of combination therapy. Doctors never prescribe it alone because HIV mutates quickly. If you take only one drug, the virus can become resistant. That’s why Sustiva is always paired with at least two other antiretroviral drugs-usually two NRTIs like tenofovir and emtricitabine. Together, they form what’s called a complete regimen.
Who Takes Sustiva and When
Sustiva is approved for adults and children over three years old who are living with HIV. It’s often chosen as a first-line treatment because it’s effective, taken once daily, and has a long track record. Many people start Sustiva when they’re first diagnosed, especially if their CD4 count is low or their viral load is high.
It’s also used in some cases for HIV prevention after a high-risk exposure-like a needlestick injury or unprotected sex with someone known to have HIV. In those situations, it’s part of a 28-day course called post-exposure prophylaxis (PEP).
But Sustiva isn’t for everyone. People with a history of severe depression, seizures, or liver disease may need to avoid it. Your doctor will check your medical history, liver function, and mental health before prescribing it.
Dosing and How to Take It Correctly
Sustiva comes in 200 mg capsules and 600 mg tablets. Most adults take one 600 mg tablet once a day, preferably on an empty stomach. Taking it with food-especially fatty meals-can increase side effects like dizziness or nausea.
The best time to take it is at bedtime. That’s because many people experience drowsiness, trouble sleeping, or strange dreams when they first start. These usually fade after a few weeks. If you take it in the morning, you might feel foggy or unsteady during the day.
Don’t skip doses. Missing even one dose can let the virus bounce back and build resistance. If you forget a dose and it’s less than 12 hours late, take it right away. If it’s more than 12 hours past, skip it and take your next dose at the regular time. Never double up.
Common Side Effects and What to Do About Them
Most people tolerate Sustiva well after the first few weeks. But in the beginning, side effects are common:
- Dizziness or lightheadedness
- Strange dreams or vivid hallucinations
- Nausea or stomach upset
- Rash (usually mild, but can be serious)
- Tiredness or trouble concentrating
A rash appears in about 25% of users. Most are mild and go away on their own. But if it spreads, blisters, or comes with fever or swelling, stop taking Sustiva and call your doctor immediately. That could be a sign of Stevens-Johnson syndrome-a rare but life-threatening reaction.
Psychiatric side effects are the most serious concern. About 5% of people develop depression, anxiety, or suicidal thoughts. If you’ve had depression before, your doctor may choose a different drug. If you start feeling hopeless, withdrawn, or have thoughts of self-harm, tell someone right away. This isn’t something to wait out.
Drug Interactions You Must Avoid
Sustiva interacts with many common medications. It changes how your liver breaks down other drugs, which can make them too strong or too weak.
Don’t take Sustiva with:
- St. John’s wort (it lowers Sustiva levels and can cause treatment failure)
- Some antifungal drugs like ketoconazole
- Certain sedatives, like midazolam or triazolam
- Some cholesterol drugs like simvastatin
- Other HIV meds like delavirdine or voriconazole
Even over-the-counter painkillers like ibuprofen or acetaminophen can become riskier when combined with Sustiva. Always tell your doctor or pharmacist about every pill, supplement, or herb you’re taking-no matter how small it seems.
What Happens If You Stop Taking Sustiva
Stopping Sustiva without medical advice can be dangerous. The virus can rebound quickly, your CD4 count can drop, and you might develop resistance to the entire NNRTI class. That means future HIV treatments could stop working.
If you need to switch medications-for example, because of side effects or pregnancy-your doctor will plan a careful transition. They’ll introduce the new drug first, then slowly phase out Sustiva. Never stop cold turkey.
Sustiva and Pregnancy
Women who are pregnant or planning to become pregnant should talk to their doctor before taking Sustiva. Studies show a small increased risk of birth defects, especially neural tube defects, when taken in the first trimester. For this reason, many providers switch pregnant women to other HIV drugs like dolutegravir.
If you’re sexually active and taking Sustiva, use reliable birth control. If you become pregnant while on it, don’t stop the medicine on your own. Contact your HIV specialist right away. They’ll help you switch safely if needed.
Alternatives to Sustiva
While Sustiva has been a backbone of HIV treatment for over 20 years, newer drugs have emerged with fewer side effects. Dolutegravir, bictegravir, and rilpivirine are now preferred first-line options in many countries because they’re better tolerated and have lower rates of neurological side effects.
Still, Sustiva remains a good choice for people who:
- Can’t afford newer drugs
- Have no history of mental health issues
- Are already stable on it with no side effects
- Live in regions where it’s the most available option
Cost matters. In the UK, Sustiva is available through the NHS at no cost to patients. Generic efavirenz is widely used in low-income countries and costs less than $50 a year.
Long-Term Use and Monitoring
If you stay on Sustiva long-term, you’ll need regular blood tests. Your doctor will check:
- Viral load (every 3-6 months)
- CD4 count (to measure immune health)
- Liver enzymes (Sustiva can raise them)
- Cholesterol and triglycerides (it can increase these)
Some people develop fat redistribution-loss of fat in the face or limbs, or gain around the abdomen. This isn’t caused directly by Sustiva, but it’s more common in people on long-term HIV regimens. Diet, exercise, and switching drugs can help.
Most importantly: stick with your treatment. People who take their HIV meds consistently have near-normal life expectancy today. Sustiva, even with its downsides, has helped millions get there.
Can Sustiva cause hallucinations?
Yes, some people taking Sustiva report vivid dreams, unusual thoughts, or even hallucinations, especially when they first start. These usually fade after 2-4 weeks. If they persist or become disturbing, talk to your doctor. This doesn’t mean you’re going crazy-it’s a known side effect of the drug’s effect on brain chemistry.
Is Sustiva still used today?
Yes, though it’s no longer the first choice in many countries. Newer drugs like dolutegravir have fewer side effects and are now preferred. But Sustiva is still widely used, especially in places where cost and availability matter. It remains a reliable, effective option for many people who tolerate it well.
Can I drink alcohol while taking Sustiva?
Moderate alcohol is usually okay, but heavy drinking increases your risk of liver damage. Sustiva is processed by the liver, and alcohol puts extra stress on it. If you drink regularly, your doctor may monitor your liver enzymes more closely. Avoid binge drinking and talk to your provider about your habits.
Does Sustiva cause weight gain?
Sustiva itself isn’t strongly linked to weight gain. In fact, some people lose weight at first due to nausea. But long-term HIV treatment can lead to changes in body fat distribution. Weight gain is more often tied to newer drugs like integrase inhibitors, not Sustiva.
What happens if I miss a dose of Sustiva?
If you miss a dose and remember within 12 hours, take it right away. If it’s been more than 12 hours, skip the missed dose and take your next one at the regular time. Don’t double up. Missing doses increases the chance the virus will become resistant to Sustiva and other similar drugs.
If you’re on Sustiva, keep your appointments, take your pills, and speak up about side effects. Your treatment plan is personal-it’s not one-size-fits-all. The goal isn’t just to survive with HIV. It’s to live well.
