References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Efavirenz was the backbone of HIV treatment worldwide for over a decade. While newer drugs have largely replaced it in UK prescribing, millions of people globally continue to take efavirenz-based regimens successfully. If you’re on efavirenz and doing well, there’s no urgency to switch — but if side effects bother you, better-tolerated alternatives are available.
This guide covers the practical essentials. For detailed dosing and side effect information, see our efavirenz medication guide and detailed efavirenz guide.
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Efavirenz in Context
| Feature | Efavirenz | Modern INSTIs |
|---|---|---|
| Efficacy | Excellent | Excellent |
| CNS side effects | Common (vivid dreams, dizziness, mood changes) | Rare |
| Resistance barrier | Low (single mutation) | High (dolutegravir, bictegravir) |
| Once daily | Yes | Yes |
| Food requirement | Empty stomach preferred | Usually none |
Who Still Takes Efavirenz?
- People stable on it for years without side effects
- Patients in settings where cost drives treatment choices
- People who can’t take integrase inhibitors due to interactions or intolerance
When to Consider Switching
Talk to your HIV team if you experience:
- Persistent vivid dreams or nightmares
- Mood changes, depression or anxiety
- Difficulty concentrating
- Dizziness that doesn’t settle
- Sleep problems
Most people notice significant improvements after switching to a dolutegravir or bictegravir-based regimen.
The Switching Process
- Discuss concerns with your HIV team
- Resistance testing if not recently done
- Choose a new regimen
- Switch (usually seamless — stop old, start new the next day)
- Viral load check at 4-8 weeks to confirm success
Read more: Efavirenz overview | Changing treatment | Biktarvy
Frequently Asked Questions
Is efavirenz still a good drug?
It’s effective but has more side effects than modern alternatives. If you’re tolerating it well, it’s still a perfectly valid option.
Will I feel different after switching?
Most people who switch from efavirenz report better sleep, improved mood and fewer dreams within weeks.
Can I switch myself?
Never change your HIV medication without your team’s guidance. They need to check resistance, hepatitis B status and interactions before switching.
Related reading
- Efavirenz for HIV: An Older NNRTI Still in Use
- Eviplera: How This Anti-HIV Drug Works
- Dolutegravir: A Complete Guide to This HIV Medication
- Injectable HIV Treatment: Everything You Need to Know
- Are HIV Tests Accurate If You're on PrEP, PEP or ART?
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
