Citation

Siddiqi O, Birbeck GL. Curr. Treat. Options Neurol. 2013; 15(4): 529-543.

Copyright

(Copyright © 2013, Current Science)

DOI

10.1007/s11940-013-0237-6

PMID

unavailable

Abstract

Opinion statement: HIV+ patients are at increased risk for developing seizures due to the vulnerability of the central nervous system to HIV-associated diseases, immune dysfunction, and metabolic disturbances. In patients with acute seizures, standard protocols still apply with urgent seizure cessation being the priority. Management of the person with established epilepsy who contracts HIV is challenging, but the decision to initiate chronic antiepileptic drug (AED) therapy in an HIV+ patient is also difficult. Chronic treatment guidelines emphasize the interactions between AEDs and antiretroviral (ARV) medications, but provide no explicit advice regarding when to initiate an AED, what medication to select, and/or the duration of treatment. Epidemiologic data regarding seizure recurrence risk in HIV + individuals is not available. The risk of further seizures likely depends upon the underlying etiology for the seizure(s) and patients' immune status and may be increased by the use of efavirenz (an ARV). The issues for consideration include AED-ARV interactions, organ dysfunction, seizure type, and drug side effects, which may worsen or be confused with symptoms of HIV and/or epilepsy. Co-administration of enzyme inducing (EI)-AEDs and ARVs can result in virological failure, breakthrough seizure activity, AED toxicity, and/or ARV toxicity. Where available, the AED of choice in HIV+ patients is levetiracetam due to its broad spectrum activity, ease of use, minimal drug interactions, and favorable side effect profile. Lacosamide, gabapentin, and pregabalin are also favored choices in patients with partial onset seizures and/or those failing levetiracetam. Where newer AEDs are not available, valproic acid may be the treatment of choice in terms of an AED, which will not cause enzyme induction-associated ARV failure, but its side effect profile causes other obvious problems. In resource-limited settings (RLS) where only EI-AEDs are available, there are no good treatment options and further pressure needs to be placed upon policymakers to address this care gap and public health threat. © 2013 Springer Science+Business Media New York.

Language: en

Keywords

human; suicide; Epilepsy; Treatment; liver failure; depression; HIV; neuroimaging; visual impairment; epilepsy; fatigue; pancreatitis; article; anorexia; vomiting; anticonvulsive agent; xerostomia; Human immunodeficiency virus infection; somnolence; neurotoxicity; Seizure; tonic clonic seizure; electrolyte disturbance; drug choice; efavirenz; drug blood level; drug potentiation; heart muscle conduction disturbance; seizure; patient compliance; acquired immune deficiency syndrome; carbamazepine; drug cost; tremor; weight gain; irritability; valproic acid; neurologic disease; felbamate; gabapentin; lamotrigine; side effect; topiramate; vigabatrin; infection; asthenia; hyperlipidemia; phenytoin; pregabalin; Antiepileptic drugs; drug half life; cerebrovascular disease; hyponatremia; mental instability; ataxia; nystagmus; etiracetam; vagus nerve stimulation; zonisamide; AIDS; antiretrovirus agent; nevirapine; zidovudine; central nervous system infection; monotherapy; aplastic anemia; diplopia; dizziness; hirsutism; virus load; drug bioavailability; focal epilepsy; highly active antiretroviral therapy; drug antagonism; drug induced headache; drug dose increase; drug dose titration; drug treatment failure; lumbar puncture; abnormal behavior; blurred vision; lopinavir plus ritonavir; progressive multifocal leukoencephalopathy; clobazam; lifestyle modification; toxoplasmosis; temporal lobectomy; Cerebrovascular disease; etravirine; hyperamylasemia; tuberculous meningitis; cryptococcal meningitis; nonnucleoside reverse transcriptase inhibitor; atazanavir plus ritonavir; hippocampal sclerosis; harkoseride; ketogenic diet; Acute management; Antiretroviral medications; cerebrospinal fluid examination; Chronic management; Highly active antiretroviral therapy; HIV viremia; Human immunodeficiency virus proteinase inhibitor; Opportunistic infections; Safe treatment