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    Liver problems. Some patients taking efavirenz have experienced serious liver problems including liver failure resulting in transplantation or death. Most of these serious side effects occurred in patients with a chronic liver disease such as hepatitis infection, but there have also been a few reports in patients without any existing liver disease.
    Tell your doctor or healthcare provider if you notice any side effects while taking efavirenz.
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    Taking efavirenz with St. John’s wort (Hypericum perforatum), an herbal product sold as a dietary supplement, or products containing St. John’s wort is not recommended. Talk with your doctor if you are taking or are planning to take St. John’s wort. Taking St. John’s wort may decrease efavirenz levels and lead to increased viral load and possible resistance to efavirenz or cross-resistance to other anti-HIV drugs.
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    So once resistance develops to efavirenz (for example), your patient just lost the entire NNRTI class as a treatment option.

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