title: Efavirenz and chronic neuropsychiatric symptoms: a cross-sectional case control study.
abstract: OBJECTIVE
  The aim of the study was to investigate symptoms of long-term central nervous system (CNS) toxicity in HIV-positive patients treated with efavirenz (EFV).
  
  
  METHODS
  We carried out a single-centre, cross-sectional case-control study comparing patients treated with EFV for at least 6 months with a matched control group. Self-administered, standardized questionnaires including the Depression, Anxiety and Stress Scales (DASS), the Cognitive Failures Questionnaire (CFQ) and a questionnaire on unusual dreams, insomnia, fatigue, dizziness, depersonalization and derealization were administered.
  
  
  RESULTS
  Data for 32 matched pairs were analysed. Significantly higher total stress scores (P=0.008) were found in the EFV group. Of the patients in this group, 19% also reported severe to extremely severe levels of stress (P=0.014), indicating increased difficulty in relaxing, and being more irritable, impatient, agitated and easily upset. Nineteen per cent of patients treated with EFV also reported severe levels of anxiety (P=0.059) as assessed with the DASS scale. This patient group also reported a higher rate of unusual dreams (P=0.049). No significant differences between groups were found for measures of cognitive impairments, fatigue, dizziness, derealization or depersonalization.
  
  
  CONCLUSIONS
  EFV-treated patients reported higher levels of severe stress and anxiety as well as a higher rate of unusual dreams than patients not treated with EFV. These differences may be an expression of persisting CNS side effects in patients who remain on EFV for a prolonged period.
authors.affiliation: Albion Street Centre, Sydney, Australia. tonia.rihs@medecine.unige.ch
authors.forename: T A
authors.initials: TA
authors.lastname: Rihs
authors.forename: K
authors.initials: K
authors.lastname: Begley
authors.forename: D E
authors.initials: DE
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Sarangapany
authors.forename: A
authors.initials: A
authors.lastname: Callaghan
authors.forename: M
authors.initials: M
authors.lastname: Kelly
authors.forename: J J
authors.initials: JJ
authors.lastname: Post
authors.forename: J
authors.initials: J
authors.lastname: Gold
mesh_terms: D000328:Adult; D000480:Alkynes; D001315:Australia / Q000453:epidemiology; D001526:Behavioral Symptoms / Q000139:chemically induced / Q000453:epidemiology*; D048588:Benzoxazines / Q000009:adverse effects; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003521:Cyclopropanes; D004325:Dreams; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced / Q000453:epidemiology*; D009483:Neuropsychological Tests; D015995:Prevalence; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects; D012650:Self Disclosure; D013315:Stress, Psychological / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; C098320:efavirenz