Discontinuation of efavirenz therapy in HIV patients due to neuropsychiatric adverse effects.

BACKGROUND: Efavirenz (EFV) is associated with neuropsychiatric manifestations that may compromise the course of HIV treatment.
METHODS: Adverse effects leading to drug discontinuation among naïve HIV-1 patients starting on a first-line antiretroviral therapy (ART) regimen were investigated by a review of patient medical files.
RESULTS: Among 276 patients, 168 (61%) were given EFV as part of the initial ART regimen. Female gender and past mental disorders were identified as predictors for selecting a non-EFV based regimen. EFV was later discontinued during the course of treatment for 90 (54%) patients. The EFV discontinuation rate due to neuropsychiatric disturbances, such as dizziness, abnormal dreams, mood changes, and anxiety, was 60%, versus 3% among patients on a third non-EFV agent based regimen (p < 0.0001). Half of the patients discontinued EFV later than 12 months after initiation of treatment, and in most cases at the discretion of the physician. Improvement in neuropsychiatric symptoms was reported by more than 90% of the patients for whom EFV discontinuation and follow-up outcome had been reported in the medical charts.
CONCLUSIONS: Discontinuation of EFV occurs in more than half the treated patients. Neuropsychiatric adverse effects are by far the most common reasons for discontinuation. Discontinuation occurs late in the course of treatment suggesting persistence of central nervous system toxicity, which may impact quality of life negatively on a long-term basis. The role of EFV as a first-line ART agent should be reconsidered in the current guidelines, in particular due to the availability of other equally effective, but less toxic, ART agents.