Severe Stress, Anxiety and Unusual Dreams May Reflect Persistent Central Nervous

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Severe Stress, Anxiety and Unusual Dreams May Reflect Persistent Central Nervous Toxicity of Efavirenz

Efavirenz (EFV; Sustiva)-based antiretroviral regimens have demonstrated strong potency and durability in the treatment of HIV infection. However, efavirenz also has been associated with symptoms of central nervous system (CNS) toxicity in some patients.

The objective of the current study was to investigate symptoms of long-term central nervous system (CNS) toxicity in HIV positive patients treated with EFV.

Researchers at the Albion Street Centre in Sydney, Australia conducted a single-centre, cross-sectional case-control study comparing patients treated with EFV for at least 6 months with a matched control group.

Self-administered, standardized questionnaires including the Depression, Anxiety and Stress Scales (DASS), the Cognitive Failures Questionnaire (CFQ) and a questionnaire on unusual dreams, insomnia, fatigue, dizziness, depersonalization and derealization were administered to the study patients.

Results

• Data for 32 matched pairs were analyzed. •Significantly higher total stress scores (P=0.008) were found in the EFV group. •Of the patients in this group, 19% also reported severe to extremely severe levels of stress (P=0.014), indicating increased difficulty in relaxing, and being more irritable, impatient, agitated and easily upset. •Nineteen per cent of patients treated with EFV also reported severe levels of anxiety (P=0.059) as assessed with the DASS scale. This patient group also reported a higher rate of unusual dreams (P=0.049). •No significant differences between groups were found for measures of cognitive impairments, fatigue, dizziness, derealization or depersonalization.

In conclusion, the authors write, "EFV-treated patients reported higher levels of severe stress and anxiety as well as a higher rate of unusual dreams than patients not treated with EFV. "

"These differences may be an expression of persisting CNS side effects in patients who remain on EFV for a prolonged period."

Albion Street Centre, Sydney, Australia. tonia.rihs@...

1/19/07

ReferenceT A Rihs, K Begley, D E , and others. Efavirenz and chronic neuropsychiatric symptoms: a cross-sectional case control study. HIV Medicine. 7(8): 544-548. November 2006.

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