Preliminary data of a prospective study on neuropsychiatric side effects after initiation of efavirenz

Objective: To assess baseline variables able to predict neuropsychiatric si de effects (NPSEs) associated with the initiation of an efavirenz (EFV)-con taining regimen in HIV-1-infected patients. Design: Open-label, prospective, observational study. Methods: Consecutive HIV-1-infected outpatients in whom EFV was prescribed underwent a psychiatric interview. At baseline and at 2, 4, and 12 weeks, p atients completed the Symptoms Check List-90-Revised (SCL-90-R), the Medica l Outcome Study for HIV-positive patients (MOS-HIV). and a standardized que stionnaire concerning potential NPSEs. Results: Preliminary data showed that discontinuation of EFV because of NPS Es occurred in 4 of 31 patients (13%). Patients who completed the follow-up showed a decrease in SCL-90-R total score (p = .004) and in several subsca les such as Interpersonal Sensitivity (p = .009). Depression (p = .001), an d Anxiety (p = .040), whereas no changes in MOS-HIV were observed. Having f ewer years of education (p = .006), having fewer baseline central nervous s ymptoms (p = .000), reporting better baseline physical status (p = .013), a nd having higher baseline scores in the Heath Transition subscale of the MO S-HIV (p = .000) and in the Somatization subscale of the SCL-90-R (p = .002 ) were associated with more NPSEs. Conclusion: Patients maintained on EFV showed a decrease in psychologic dis tress related to self-image, depression, and anxiety, without any effect on quality of life. Patients with a lower level of education, those who feel physically and psychologically better at baseline than in the past, and tho se who suffer from more distress as a result of physical complaints may be at greater risk of reporting more NPSEs after EFV initiation.