Citation

Sarfo FS, Sarfo MA, Chadwick D. eNeurologicalSci 2016; 3: 21-25.

Copyright

(Copyright © 2016)

DOI

10.1016/j.ensci.2015.12.002

PMID

unavailable

Abstract

Background Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) is associated with neuropsychiatric toxicity. Little is known about the risk of short- and long-term neuropsychiatric toxicity in sub-Saharan Africa, where NNRTIs are widely used in first-line combination ART. This observational study assessed the risk of neuropsychiatric toxicity in Ghanaian patients starting first-line ART between 2004 and 2010 at a single centre.

METHODS In this retrospective observational study, frequencies of documented neuropsychiatric toxicity events were assessed and time to events calculated using a Kaplan-Meier analysis. Associations of neuropsychiatric toxicity with specific NNRTIs and other explanatory variables were examined using Cox proportional hazards modelling.

RESULTS Of 3999 patients initiating NNRTI-based ART, who were followed for a median of 30 (0.25-90) months (11,237 person years), 218 (5.5%) reported symptoms of neuropsychiatric toxicity at a rate of 21.4 events per 1000 person-years (95% CI, 18.8-24.2/1000 py). Events were more common with efavirenz than nevirapine (7.6% versus 2.4%), were usually reported within the first 2 months of ART initiation and persisted up to 84 months in a few patients. The most commonly reported neuropsychiatric adverse drug reactions were insomnia (50%), headaches (8%), dizziness (7%) and abnormal dreams (6%). The factors independently associated with neuropsychiatric toxicity were BMI < 16 kg/m2 (aHR of 1.44 [95% CI, 1.02-2.03]) and use of efavirenz (aHR 3.29 [95% CI, 2.32-4.69]). Substitution of NNRTI on account of toxicity was reported in up to 17% of patients experiencing neuropsychiatric events.

CONCLUSIONS NNRTI-related neuropsychiatric toxicity, mainly due to efavirenz, was infrequently documented in this Ghanaian cohort under routine clinical care settings. Regimens with more favourable tolerability will be needed as first-line agents in sub-Saharan Africa in the coming years. © 2016 The Authors

Language: en

Keywords

adult; human; female; male; incidence; insomnia; suicidal ideation; aggression; psychosis; Africa; suicide attempt; HIV; lamivudine; risk factor; major clinical study; mental disease; controlled study; retrospective study; Human immunodeficiency virus infection; priority journal; headache; somnolence; vertigo; anxiety disorder; drowsiness; practice guideline; confusion; drug safety; efavirenz; seizure; follow up; long term care; drug efficacy; tremor; drug withdrawal; erectile dysfunction; dystonia; myalgia; alanine aminotransferase; aspartate aminotransferase; creatinine blood level; ataxia; nevirapine; stavudine; zidovudine; dizziness; body mass; virus load; hyperactivity; dysarthria; Article; observational study; mood change; alanine aminotransferase blood level; aspartate aminotransferase blood level; Human immunodeficiency virus infected patient; antiviral therapy; hepatitis B surface antigen; Ghanaian; Neuropsychiatric toxicity; NNRTI