Long-Term Neuropsychiatric Disorders on Efavirenz-Based Approaches
June 8, 2005
Following the commercialization of efavirenz as an antiretroviral for HIV treatment, its use was associated with the onset of neuropsychiatric disturbances. While most such problems are typically mild and generally disappear within a few weeks, token cases of psychosis, major depression, and suicidal ideation have been reported. Data on long-term efavirenz toxicity are scarce.
In the present study, researchers sought to assess neuropsychiatric disorders and their relation to efavirenz plasma levels as well as quality of life, psychologic status, and adherence in HIV-positive patients on long-term efavirenz-based antiretroviral treatment. Through a cross-sectional study, they compared 60 patients on an efavirenz-based regimen (EFV group) with 60 patients on a protease inhibitor-containing regimen (PI group) for at least one year. The researchers assessed the subjects' adherence, psychologic status, quality of life, efavirenz plasma levels and adverse events. Mean time on treatment was 91.1 ¡À 39.5 weeks in the EFV group and 119.9 ¡À 67.4 weeks in the PI group.
Compared with the PI group, the EFV group more frequently reported mild dizziness, sadness, mood changes, irritability, lightheadedness, nervousness, impaired concentration, abnormal dreams, and somnolence (PThe researchers "observed that neuropsychiatric disorders may persist after a mean of 2 years on efavirenz therapy." While they acknowledged that the most frequently reported adverse events ¡°may be related to individual psychologic factors, the differences found between the 2 study groups leads us to consider that efavirenz may play a key role in their maintenance. Fatigue was reported by an important proportion¡ of patients in both groups. A detailed analysis of this symptom shows that several factors, such as the psychologic impact of this chronic disease on patients, emotional status, may be even more relevant than the antiretroviral therapy itself.
To conclude, according to our data, neuropsychiatric disorders may persist in the long term in a significant proportion of patients on efavirenz treatment. These disturbances were mild and clinically tolerable and did not impair patients quality of life and psychologic status. Because adherence decreased with time, interventions to enhance long-term compliance should be applied in clinical practice, the authors wrote.
Journal of Acquired Immune Deficiency Syndromes
04.15.05; Vol. 38; No. 5: P. 560-565; Carmina R. Fumaz, M.A.; Jose A. Muñoz-Moreno, B.S.; José Moltó, M.D.; Eugínia Negredo, Ph.D.; Maria José Ferrer, M.A.; Guillem Sirera, Ph.D.; Nuria Pérez-Alavarez, B.S.; Guadalupe Gómez, Ph.D.; David Burger, Ph.D.; Bonaventura Clotet, Ph.D.
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.