Original Research

Efavirenz: A review of the epidemiology, severity and management of neuropsychiatric side-effects

Razia Gaida, Ilse Truter, Christoffel Grobler
South African Journal of Psychiatry | Vol 21, No 3 | a783 | DOI: https://doi.org/10.4102/sajpsychiatry.v21i3.783 | © 2015 Razia Gaida, Ilse Truter, Christoffel Grobler | This work is licensed under CC Attribution 4.0
Submitted: 21 February 2015 | Published: 01 August 2015

About the author(s)

Razia Gaida, Department of Pharmacy, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
Ilse Truter, Department of Pharmacy, Nelson Mandela Metropolitan University, Port Elizabeth; and Drug Utilisation Research Unit, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
Christoffel Grobler, Department of Psychology, Nelson Mandela Metropolitan University; Elizabeth Donkin Hospital, Port Elizabeth, South Africa

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South Africa has the highest proportion of HIV-positive people in the world. HIV cannot be cured; however, there are several major classes of drugs used in its management. Efavirenz is one such agent of the class non-nucleoside reverse transcriptase inhibitors which inhibits the replication of the virus. Efavirenz is associated with causing neuropsychiatric side-effects (NPSEs), with almost 50% of patients experiencing at least one NPSE while on treatment. The NPSEs tend to occur within the first few days of initiation of therapy and resolve spontaneously within the first 4 - 6 weeks, with the most commonly reported being dizziness, insomnia, headache, abnormal dreams and impaired concentration. The plasma level of efavirenz and genetic polymorphisms are thought to play a role in the development of such NPSEs. NPSEs need to be treated according to severity. If necessary, efavirenz may be replaced with nevirapine or lopinavir/ritonavir. It should be remembered that nevirapine may also produce some severe side-effects such as skin abnormalities and hepatotoxicity. The monitoring of patients receiving efavirenz therapy should be ongoing, with those with a history of mental illness requiring closer monitoring than others. 



Efavirenz; neuropsychiatric; epidemiology; management; Human Immunodeficiency Virus (HIV)


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