title: Neuropsychiatric Effects of HIV Antiviral Medications.
abstract: The development of antiretroviral therapy (ART) has dramatically increased the lifespan of HIV patients but treatment is complicated by numerous adverse effects and toxicities. ART complications include neuropsychiatric, metabolic, gastrointestinal, cardiac, and numerous other toxicities, and clinicians often have to choose one toxicity over another to offer the best medication regimen for a patient. Some antiviral drugs cause significant neuropsychiatric complications, including depression, cognitive impairment, and sleep disturbance. Even in careful studies, it may be difficult to determine which effects are related to the virus, the immune system, or the treatment. Of the six currently marketed classes of antiviral drugs, the nucleoside reverse transcriptase inhibitors and the non-nucleoside reverse transcriptase inhibitors have been most commonly associated with neuropsychiatric complications. Within these classes, certain drugs are more likely to cause difficulty than others. We review the contention regarding the central nervous system (CNS) complications of efavirenz, as well as debate about the role of CNS penetration in drug effectiveness and toxicity. A thorough working knowledge of the neuropsychiatric consequences of ART allows clinicians to tailor treatment more successfully to individual patients as well as to identify ART more quickly as the source of a problem or symptom.
authors.affiliation: Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, USA. glenn@jhmi.edu.|Department of Medicine, Meyer 119 Johns Hopkins Hospital, Baltimore, 21287, USA. glenn@jhmi.edu.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Treisman
authors.affiliation: Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, USA.|Department of Medicine, Meyer 119 Johns Hopkins Hospital, Baltimore, 21287, USA.
authors.forename: Olivia
authors.initials: O
authors.lastname: Soudry
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000494:pharmacology; D003072:Cognition Disorders / Q000139:chemically induced; D003863:Depression / Q000139:chemically induced; D006801:Humans; D001523:Mental Disorders / Q000139:chemically induced*; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D012893:Sleep Wake Disorders / Q000139:chemically induced
chemical_list: D019380:Anti-HIV Agents