Neuropsychiatric symptoms in human immunodeficiency virus (HIV)-infected patients may
be a late complication of efavirenz treatment. This study: 1) assessed the level of neuropsychiatric
symptoms in HIV-infected patients on long-term efavirenz therapy; 2) explored the effect of a switch
to non-efavirenz containing anti-retroviral treatment on neuropsychiatric symptoms. A consecutive
series of 47 HIV-infected participants on long-term efavirenz treatment were included in an
observational clinical trial. Participants completed three self-report questionnaires on neuropsychiatric
symptoms. Patients switching to a non-efavirenz regimen were retested 2 weeks and 3 months after switching. Data were
analyzed using repeated measures ANOVA to assess the effect of switching over time. A change in the percentage of
patients scoring above norm scores after switching was analyzed using Chi square. Neuropsychiatric symptoms were
common among HIV-infected patients on long-term efavirenz therapy, mainly depression, anxiety, stress, insufficiency in
thinking and paranoia. After switching, these symptoms improved significantly to (near) normal levels. Our results show
that neuropsychiatric symptoms are common among HIV-infected subjects and may be caused by long-term efavirenz
use. Neuropsychiatric assessment, such as the Depression, Anxiety and Stress scale and Symptom Checklist 90, can
identify those that may benefit from the discontinuation of efavirenz.
Keywords: Efavirenz, efavirenz discontinuation, long-term efavirenz, neuropsychiatric assessment, self-report questionnaires.
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