Preliminary data of a prospective study on neuropsychiatric side effects after initiation of efavirenz.
OBJECTIVE
To assess baseline variables able to predict neuropsychiatric side effects (NPSEs) associated with the initiation of an efavirenz (EFV)-containing regimen in HIV-1-infected patients.


METHODS
Open-label, prospective, observational study.


METHODS
Consecutive HIV-1-infected outpatients in whom EFV was prescribed underwent a psychiatric interview. At baseline and at 2, 4, and 12 weeks, patients completed the Symptoms Check List-90-Revised (SCL-90-R), the Medical Outcome Study for HIV-positive patients (MOS-HIV), and a standardized questionnaire concerning potential NPSEs.


RESULTS
Preliminary data showed that discontinuation of EFV because of NPSEs occurred in 4 of 31 patients (13%). Patients who completed the follow-up showed a decrease in SCL-90-R total score (p =.004) and in several subscales such as Interpersonal Sensitivity (p =.009), Depression (p =.001), and Anxiety (p =.040), whereas no changes in MOS-HIV were observed. Having fewer years of education (p =.006), having fewer baseline central nervous symptoms (p =.000), reporting better baseline physical status (p =.013), and having higher baseline scores in the Heath Transition subscale of the MOS-HIV (p =.000) and in the Somatization subscale of the SCL-90-R (p =.002) were associated with more NPSEs.


CONCLUSIONS
Patients maintained on EFV showed a decrease in psychologic distress related to self-image, depression, and anxiety, without any effect on quality of life. Patients with a lower level of education, those who feel physically and psychologically better at baseline than in the past, and those who suffer from more distress as a result of physical complaints may be at greater risk of reporting more NPSEs after EFV initiation.
Blanch
J
J
Clinical Institute of Psychiatry and Psychology, Institut De Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Fundació Clinic per a la Recerca Biomédica, Hospital Clínic Universitari de Barcelona, Spain. jblanch@clinic.ub.es
Martínez
E
E
Rousaud
A
A
Blanco
J L
JL
García-Viejo
M A
MA
Peri
J M
JM
Mallolas
J
J
De Lazzari
E
E
De Pablo
J
J
Gatell
J M
JM
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects*; D048588:Benzoxazines; D003521:Cyclopropanes; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010078:Oxazines / Q000009:adverse effects*; D010352:Patient Dropouts; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D010078:Oxazines; D018894:Reverse Transcriptase Inhibitors; C098320:efavirenz