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Efavirenz has a long and variable half-life of 40-55 hours at steady state.2 Therapeutic concentrations have been measured up to several weeks after drug intake cessation in some patients.3 Efavirenz is an inducer of hepatic cytochrome P450 (CYP450), a group of enzymes involved in the metabolism of a wide variety of drugs.4 Induction of CYP3A4 leads to reductions in plasma concentrations of coadministered drugs that are metabolized by CYP3A4, potentially diminishing their therapeutic effects.5-7 Moreover, efavirenz itself is primarily metabolized by CYP2B6 and racially distributed pharmacogenetic differences in CYP2B6 activity seem to contribute to the high interindividual variability in efavirenz exposure.8 Etravirine, a next generation NNRTI, is approved for use in combination with other ARVs in treatment-experienced patients.9 Unlike older NNRTIs, etravirine retained efficacy in the presence of some common NNRTI-associated resistance mutations

The inhibition of protein kinase C (PKC), NADPH oxidase, and NF-B signaling exhibited anti-oxidative and anti-inflammatory effects in endothelial cells, accompanied by the upregulation of protective anti-oxidative enzymes [57]

Pathogenesis Spontaneous and following treatment with hepatotoxins that are carcinogenic xenobiotics

Our guide on supplements to take with GLP-1 covers the full landscape of supportive supplementation