Effect of Efavirenz (Sustiva) on Neuropsychiatric Adverse Events in HIV-HCV Coinfected
Patients Treated with Interferon
By
Liz Highleyman Interferon-based
therapy for chronic hepatitis C virus (HCV) infection is associated with neuropsychiatric
side effects, especially depression, that often lead to dose reduction or treatment
discontinuation.
 | Sustiva
Tablet | | Atripla
Tablet |
The
commonly used antiretroviral drug efavirenz
(Sustiva; also a component of the Atripla
fixed-dose combination pill) also frequently produces neuropsychiatric side effects,
ranging from depression to insomnia to unusual dreams or nightmares. However,
efavirenz may be a good option for HIV-HCV
coinfected individuals, since it is seldom associated with liver toxicity.
As
reported in the September 1, 2008 Journal of Acquired Immune Deficiency Syndromes,
Spanish researchers conducted a study to assess the effect of efavirenz on the
incidence of neuropsychiatric adverse events in HIV-HCV coinfected patients receiving
interferon.
The
analysis included 266 coinfected participants starting a course of interferon
(91% pegylated interferon [Pegasys or
PegIntron], the rest conventional
interferon) plus ribavirin at the HIV Outpatient Clinic at Ramón y
Cajal Hospital in Madrid. Of these, 53 (20%) received concomitant efavirenz and
213 (80%) did not. Most patients taking efavirenz (92%) were already on that drug
before starting interferon, for a mean of 26 months.
Results
•
Neuropsychiatric
side effects were frequent overall.
•
There was no
statistically significant difference in incidence of such events in the efavirenz
and non-efavirenz groups, though there was a trend in this direction (79% vs 65%'
P = 0.051).
•
Mood disorders
(e.g., sadness, apathy) were reported more frequently by patients taking efavirenz
compared with those not taking the drug (36% vs 23%; P = 0.046).
•
However, the
likelihood of antidepressant use was similar in both groups (23% vs 16%; P = 0.25).
•
The incidence
of anxiety, insomnia, irritability, poor concentration or memory, and headache
was similar in both groups, as was the likelihood of using anxiolytic (anxiety-reducing)
or hypnotic (sleep-inducing) agents.
•
Patients with
cirrhosis had a slightly lower rate of neuropsychiatric adverse events, in particular
insomnia, but the difference did not reach statistical significance (70% vs 85%;
P = 0.2).
•
Only 10 patients
(3.8%) discontinued interferon therapy due to neuropsychiatric adverse events,
without differences between the efavirenz and non-efavirenz groups.
Based
on these findings, the study authors concluded, "Neuropsychiatric adverse
events are common in HIV-HCV patients receiving interferon, usually mild or moderate."
They
added that, "Efavirenz may favor symptoms of mood disorders, although it
was not related to an increased risk of significant depression requiring specific
treatment."
Service of Infectious Diseases, Neurology, and Pharmacy,
Hospital Ramón y Cajal, Madrid, Spain.
9/09/08
Reference
C
Quereda, I Corral, A Moreno, and others. Effect of treatment with efavirenz on
neuropsychiatric adverse events of interferon in HIV/HCV-coinfected patients.
Journal of Acquired Immune Deficiency Syndromes 49(1): 61-63. September
1, 2008. (Abstract). |
