Effect of treatment with efavirenz on neuropsychiatric adverse events of interferon in HIV/HCV-coinfected patients.
BACKGROUND
Mood disorders and other neuropsychiatric disorders are common adverse events limiting tolerability of alpha-interferon (IFN) therapy for hepatitis C virus (HCV). Because efavirenz (EFV) frequently produces neuropsychiatric side effects, we studied the effect of EFV in the incidence of these side effects in HIV/HCV patients receiving IFN.


METHODS
Prospective cohort of HIV/HCV patients receiving IFN and ribavirin. Adverse events and concomitant medications were systematically recorded once monthly.


RESULTS
Among 266 HIV/HCV patients starting a course of IFN (91% pegylated IFN) plus ribavirin, 53 (20%) received concomitant EFV and 213 (80%) did not. Most EFV patients (92%) were already on EFV before starting IFN (mean 26 months). Neuropsychiatric side effects were frequent, without significant differences between both groups (79% vs 65%, P = 0.051), and only 10 patients discontinued IFN. Mood disorders were reported more frequently in EFV patients (36% vs 23%, P = 0.046), but antidepressant therapy use was similar in both groups. The incidence of anxiety, insomnia, irritability, headache or prescription of anxiolytics or hypnotics was similar.


CONCLUSIONS
Neuropsychiatric adverse events are common in HIV/HCV patients receiving IFN, usually mild or moderate. EFV may favor symptoms of mood disorders, although it was not related to an increased risk of significant depression requiring specific treatment.
Quereda
Carmen
C
Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain. cqueredar.hrc@salud.madrid.org
Corral
Iñigo
I
Moreno
Ana
A
Pérez-Elías
María J
MJ
Casado
José L
JL
Dronda
Fernando
F
Rodríguez-Sagrado
Miguel A
MA
Hernández
Beatríz
B
Moreno
Santiago
S
D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000139:chemically induced; D048588:Benzoxazines / Q000627:therapeutic use*; D003521:Cyclopropanes; D003863:Depression / Q000139:chemically induced; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects*; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced*; D019964:Mood Disorders / Q000139:chemically induced
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D016898:Interferon-alpha; C098320:efavirenz