A review of trials investigating efavirenz-induced neuropsychiatric side effects and the implications

ABSTRACT

Efavirenz is part of the first-line treatment for HIV patients including those in South Africa with approximately 50% experiencing neuropsychiatric side effects. A systematic review of papers reporting neuropsychiatric side effects with efavirenz published between January 2001 and December 2014 was performed, to provide guidance. 13 articles were reviewed. Patient ages ranged between 37 to 41 years, with a high percentage males. Scales used to measure incidence and severity of side effects were varied; with disease severity or stage not reported. Patients with psychoses were excluded. Most commonly reported side effects were a reduction in sleep quality, depression, dizziness and anxiety. These were generally mild and not warranting discontinuation of efavirenz. It is difficult to directly compare the studies. Standardised methods need to be introduced and all patient groups represented including the elderly, children, patients with active symptomatic illness and more women especially among the African population.

KEY WORDS:

• efavirenz
• neuropsychiatric side effects
• HIV
• systematic review
• pharmacovigilance

Financial and competing interests disclosure

The authors received a small grant from the Karolinska Institute to help with the writing of the paper. The write up of this paper was in part support by the Karolinska Institutet as well as VR-Link grant from Swedish Research Council (VR-Link 2013-6710). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• The neuropsychiatric side effects caused by efavirenz may persist longer than the first 4–6 weeks of treatment as initially thought.

• These side effects are not generally severe enough to warrant the discontinuation of EFV.

• Older patients, pediatric patients and patients with active symptomatic mental illness need to be included in studies to obtain a representative sample. Similarly, for Africa there needs to be more women included in studies monitoring the side effects of treatments for HIV.

• Patients need to be provided with continuous adherence education to enhance the effectiveness of treatment.