Efavirenz (Sustiva) can cause neuropsychiatric adverse events - including depression, insomnia, and unusual dreams - which may lead to treatment discontinuation.

Researchers with Dupont Circle Physicians Group, a large HIV specialty practice in Washington, DC, conducted a retrospective analysis of outcomes in 40 patients with undetectable or low HIV viral loads who experienced neuropsychiatric side effects or elevated lipid levels and switched from efavirenz to nevirapine (Viramune).

Results

36 of the 40 patients had undetectable viral loads prior to the treatment switch; HIV RNA remained undetectable after the switch for a median of 25 months (range 6-59).

4 patients had persistent low viral loads before the switch; HIV RNA remained at low levels in 2 of the 4, and became undetectable in the other 2.

20 patients who reported neuropsychiatric symptoms before the switch (depression, anxiety, or fatigue, with or without sleep disturbances) demonstrated significant improvement.

15 patients experienced complete resolution of symptoms.

4 patients with isolated sleep disturbances experienced significant improvement.

No patients developed a skin rash after switching to nevirapine.

Mean lipid levels improved significantly following the switch:

- total cholesterol decreased by 17.8 mg/dL;
- low-density lipoprotein (LDL or "bad") cholesterol decreased by 25.5 -g/dL;
- triglycerides decreased by 70.1 mg/dL;
- high-density lipoprotein (HDL or "good") cholesterol increased by 5.3 mg/dL.

Conclusion

In conclusion, the authors wrote, "These results demonstrate that patients who are virologically controlled on efavirenz-containing regimens with treatment-associated side effects can be successfully switched to nevirapine-containing therapy with maintenance of virologic control, reduction in neuropsychiatric side effects, and improvement in dyslipidemia."

12/08/06

Reference
D J Ward and J M Curtin. Switch from efavirenz to nevirapine associated with resolution of efavirenz-related neuropsychiatric adverse events and improvement in lipid profiles. AIDS Patient Care and STDs 20(8): 542-548. August 2006.