Used For:

• Used as lifelong antiretroviral therapy (ART)Also used in post-exposure prophylaxis (PEP) or pre-treatment regimens

Contraindications:

• Do not use in patients with:Hypersensitivity to tenofovir, lamivudine, or efavirenzSevere liver diseaseHistory of severe psychiatric illness (psychosis, severe depression, suicidal ideation)Concurrent use with drugs that have serious interactions with efavirenz (e.g., certain sedatives, ergot derivatives)Pregnancy – first trimester (relative contraindication due to efavirenz)

Side Effects:

• Common Side EffectsCentral Nervous System (Efavirenz-related)DizzinessVivid dreams or nightmaresInsomniaConfusion or difficulty concentratingMood changesGastrointestinalNausea, vomitingDiarrheaAbdominal discomfortOthersSkin rash (usually mild)FatigueHeadache🚨 Serious (but less common) Side EffectsSevere depression, suicidal thoughts, psychosisSevere skin reactions (Stevens–Johnson syndrome)Liver toxicity (elevated liver enzymes, hepatitis)Kidney damage (tenofovir-related)Bone mineral loss / osteoporosisLactic acidosis (rare but life-threatening)

Precautions:

• Take regularly without missing doses → missing doses causes drug resistanceUse cautiously in:Patients with mental health disordersRenal disease (monitor creatinine)Liver disease or hepatitis B/C co-infectionRegular monitoring required:CD4 countHIV viral loadLiver & kidney function testsDo not stop ART abruptly without medical adviceSafe sex practices must continue (ART reduces but does not eliminate transmission risk)

Dietary Restrictions:

• Take on an empty stomach at bedtime→ reduces dizziness & CNS side effects of efavirenzAvoid alcohol (↑ liver toxicity and CNS effects)Avoid grapefruit and St. John’s wort (drug interactions)Maintain adequate calcium & vitamin D intake (bone protection)Maintain good hydration