Although some trends emerge from these retrospective data, they suggest that no clear, unified outline can currently be defined for these multi-organ drug-induced reactions. Instead, a constellation of various symptoms and signs were recorded, that might be sorted in different patterns according to the causal drug, a finding that might indeed improve accurate identification of the causative drug in patients receiving several principal medications at a time. A national prospective study systematically collecting standardized data is required better to define the outlines of these severe adverse drug reactions and to evaluate prognostic data.

We describe 7 cases of renal tubular injury in HIV-infected patients receiving an antiretroviral regimen containing tenofovir. Our patients (5 women and 2 men) developed renal tubular dysfunction, with hypophosphatemia, normoglycemic glycosuria, proteinuria, and decrease of creatinine clearance. The first biologic signs of renal toxicity were observed after duration of tenofovir treatment from 5 weeks to 16 months, and they resolved less than 4 months after discontinuation of tenofovir. Six patients had a low body weight (<60 kg). Five patients received low doses of ritonavir, and 1 received didanosine. In 5 patients, the signs resolved with the discontinuation of only the tenofovir. A renal biopsy performed in 1 patient was consistent with tubulointerstitial injury. Proximal tubulopathy appears to be a rare adverse effect of long-term tenofovir therapy. In patients with low weight or mild preexisting renal impairment, regular monitoring of tubulopathy markers could lead to early detection of this dysfunction.

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The Sensio study objectives were to assess the outcome of neuropsychiatric adverse reactions (NPAR) that develop after initiation of efavirenz (EFV) therapy, to ascertain the late NPAR after a 3-month treatment period, to evaluate the impact of NPAR on patients' quality of life (QoL) in a real-life population. MethodsDuring a 6-month period, consecutive HIV-infected adult outpatients receiving an ongoing EFV therapy for at least 3 months were asked to ®ll in a speci®cally designed self-administered questionnaire addressing sleep disturbances, behavioural changes, mood disturbances, anxiety, cognitive disorders, hallucinations, dizziness and the general impact on patients' QoL. ResultsA total of 174 questionnaires were analyzed. The main late emergent NPAR were sleep disorders: abnormal dreams 24.7%, nocturnal waking 19.6%, trouble falling asleep 17.8%; cognitive disorders: memory disorders 23.0%, impaired concentration 18.9%; anxiety 15.5%; mood disorders: sadness 19.3%, suicidal ideations 9.2%. Global neuropsychic discomfort was moderate to severe in 23% of patients after a 3-month treatment period. ConclusionNPAR occur mainly during the ®rst month of EFV therapy but often persist thereafter. A signi®cant percentage of patients reported suicidal ideations at the time of the study. Our results suggest the need for routine screening for NPAR among patients receiving EFV therapy and better management. IntroductionNeuropsychiatric adverse reactions (NPAR) commonly occur within the ®rst days following initiation of treatment with efavirenz (EFV) and resolve in 2±4 weeks of EFV use [1]. NPAR have been reported in about 50% of the patients treated with this drug in clinical trials. Central nervous system disturbances range from dizziness to hallucinations, including frequent nightmares, unusual dreams and insomnia. Symptoms are usually mild to moderate [2]. The Sensio study was focused on the NPAR self-reported by HIV-positive patients with an ongoing antiretroviral regimen including EFV in real-life conditions. The objectives were to assess the outcome of NPAR that develop after initiation of EFV therapy, to ascertain the late adverse reactions of EFV after a 3-month treatment period, and to evaluate the NPAR impact on patients' quality of life (QoL). Patients and methodsDuring a 6-month period, in three HIV outpatient units, all consecutive HIV-infected adults receiving an ongoing EFV therapy for at least 3 months were concerned by the Sensio study. Capacity to understand and answer a questionnaire in the French language was required. Patients meeting these inclusion criteria were asked by investigators to complete [7]. First, patients had to report their current antiretroviral treatment and the date of EFV initiation. Then, patients assessed their own psychological and physical status by completing the following items: sleep disturbances (trouble falling asleep, nocturnal waking, early morning waking, nightmares, perturbed dreams, day-time drowsiness, fatigue) behavioural changes (euphoria, irritability, tobacco ...