I've been doing well on nevirapine for almost 3 years. Now my doc wants me to switch to efavifenz. I asked her why and she said that with time nev. will be toxic to my liver and resistance is more likely to occur than with efav. Is she right?
No, not exactly. While it’s true that nevirapine has more liver toxicity than efavirenz, the toxicity occurs in the first months of therapy. If you’ve been on it for for almost 3 years, you’re out of danger.
As for resistance, it’s also true that failure of nevirapine can lead to broader cross-resistance within the NNRTI class than failure of efavirenz, but resistance only happens if you fail. You’ve been taking it for 3 years without failure, so resistance doesn’t sound like an issue.
I’m not telling you not to switch. Efavirenz is a better drug to start with than nevirapine, but you’re not starting therapy. You’ll probably also have to deal with some efavirenz side effects, at least in the beginning.