Long-Term Neuropsychiatric Disorders among Patients Using Efavirenz-Based HAART: Quality of Life, Psychologic Issues and Adherence

Efavirenz (Sustiva) is a potent and durable non nucleoside reverse transcriptase inhibitor (NNRTI) anti-HIV agent that has been associated with neuropsychiatric disorders. Yet little is known about its long-term toxicity. The aim of the current study was to assess neuropsychiatric disorders and their relation to efavirenz plasma levels as well as quality of life, psychologic status and adherence in HIV-infected patients on long-term efavirenz-based antiretroviral therapy.

The current study was cross-sectional and compared 60 patients on an efavirenz-based approach (EFV group) and 60 patients on a protease inhibitor-containing regimen (PI group) for at least 1 year. Adverse events, efavirenz plasma levels, quality of life, psychologic status, and adherence were assessed.

Results

The mean time on treatment was 91.1 +/- 39.5 weeks in the EFV group and 119.9 +/- 67.4 weeks in the PI group.

Mild dizziness, sadness, mood changes, irritability, lightheadedness, nervousness, impaired concentration, abnormal dreams, and somnolence were reported more frequently in the EFV group than in the PI group (P < 0.05).

Forty-nine of 60 patients presented with therapeutic efavirenz plasma levels. Efavirenz plasma levels were similar in subjects with and without neuropsychiatric disorders.

No significant differences were found between the EFV group and the PI group regarding quality of life and psychologic status.

Sixty percent of patients in the EFV group and 55% in the PI group reported adherence >/=95%.

Conclusions

In conclusion, the authors write, “Mild and clinically tolerable neuropsychiatric disorders may persist in patients after a mean of 2 years using an efavirenz-based approach. Quality of life and psychologic status remained good in both study groups.”

“Interventions to enhance long-term adherence should be applied in clinical practice.”

From the *Lluita contra la SIDA Foundation, HIV Unit-Germans Trias i Pujol Hospital, Autonomous University of Barcelona, Barcelona, Spain; daggerHIV Unit-Germans Trias i Pujol Hospital, Barcelona, Spain; double daggerStatistics and Operations Research Department, Polytechnic University of Catalunya, Barcelona, Spain; section signDepartment of Clinical Pharmacy, University Medical Centre Nijmegen, Nijmegen, The Netherlands; and parallelIrsiCaixa Foundation, Hospital Germans Trias I Pujol Hospital, Barcelona, Spain.

04/01/05

Reference
C R Fumaz and others. Long-Term Neuropsychiatric Disorders on Efavirenz-Based Approaches: Quality of Life, Psychologic Issues, and Adherence. Journal of Acquired Immune Deficiency Syndromes 38(5): 560-565. April 15, 2005.