Tolerance of Efavirenz-Induced Central Nervous System Side Effects in HIV-Infected Individuals with a History of Substance Abuse

Abstract

Purpose: There is no published data looking at tolerance of efavirenz (EFV) in patients who abuse cocaine or alcohol (EtOH). The objective of this study was to determine whether individuals with a current or past history of cocaine or EtOH abuse are more likely to experience EFV-induced central nervous system (CNS) side effects that warrant discontinuation of EFV compared with those who do not abuse substances. Method: Retrospective chart review of all patients who received a nonnucleoside reverse transcriptase inhibitor (NNRTI) at an inner city Ryan White Title III-supported health clinic during 1992-2003. Results: During the study period, 99/279 (78% African American, 88% male) patients were prescribed an NNRTI. Patients on an NNRTI with either a history of or current substance abuse (SA) abused cocaine (30%), EtOH (70%), or marijuana (33%). Of these, 38% abused more than one substance. There were 39/63 EFV patients who were substance abusers compared with 16/36 patients not on EFV who were substance abusers (p = .09). Examining patients on EFV, 6/24 with SA and 7/39 without SA reported a CNS side effect (p = .54). Among patients on EFV, 4/24 with SA versus 13/39 without SA reported stopping EFV (p = .24). Conclusion: SA did not have a significant effect on patients' ability to remain on EFV. Patients who abused cocaine or EtOH or smoked marijuana were at no more risk of exhibiting CNS side effects than those who denied a history of substance abuse.

Keywords:

• CNS side effects
• efavirenz
• substance abuse