Outcome of neuropsychiatric symptoms related to an antiretroviral drug following its substitution by nevirapine: the <scp>RELAX</scp> study

Pedrol, Enric; Llibre, JM; Tasias, María; Curran, Adrián; Jm, Guardiola; Deig, Elisabeth; Guelar, Ana; Martínez-Madrid, OJ; Tikhomirova, Lidia; Ramírez, Rafael

doi:10.1111/hiv.12298

Cited by 13 publications

(14 citation statements)

References 18 publications

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“…53 Neuropsychiatric symptoms attributed to antiretroviral drugs (mainly efavirenz) improved significantly following substitution with another drug (eg, nevirapine). 117,118 what depression and anxiety do to HIV infection Depression causes various direct and indirect morbidities, which include suicidal behavior, 119 increased use of health care facilities, 120 and poor QoL. 80 It is important to identify depression among PLWHA, as depression is associated with increased chances of HIV transmission 121 and ART non adherence, [122][123][124] resulting in failure to suppress viral load 125 and increased HIV disease progression.…”

Section: Effects Of Antiretroviral Drugsmentioning

confidence: 99%

Prevalence, impact, and management of depression and anxiety in patients with HIV: a review

Bakhla¹,

Saini²

2016

NBHIV

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The prevalence of depression and anxiety in people living with HIV/AIDS (PLWHA) ranges from 7.2% to 71.9% and 4.5% to 82.3%, respectively. This wide variation is attributed to differences in sample size and characteristics, and methodology for assessment of anxiety and depression. Moreover, anxiety and depression increase the morbidity of HIV by poor adherence to treatment and various other significant mechanisms. Early identification and effective management of these disorders is associated with improved antiretroviral adherence and improved quality of life in PLWHA. Different treatment modalities, including pharmacological and nonpharmacological therapies, are used for the management of anxiety and depression in PLWHA. Benzodiazepines are indicated for short periods of time. Clonazepam and lorazepam are safe in terms of drug-drug interactions and may be preferred. Selective serotonin reuptake inhibitors are safer than tricyclic antidepressants. Though the different selective serotonin reuptake inhibitors are supposed to be equally effective, to avoid interactions with antiretrovirals, the better options are sertraline, citalopram, and escitalopram. Various nonpharmacological therapies, including cognitive behavior therapy, interpersonal therapy, supportive psychotherapy, cognitive-behavioral-oriented group psychotherapy, experiential group psychotherapy, cognitive-behavioral stress management, stress management interventions, cognitive remediation therapy, mindfulness-based therapy, and aerobic and resistance exercise have been reported to be useful in treating depression among PLWHA. However, definitive evidence to decide which nonpharmacological intervention is most beneficial for the management of anxiety and depression in PLWHA is still required.

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Section: Effects Of Antiretroviral Drugsmentioning

confidence: 99%

Prevalence, impact, and management of depression and anxiety in patients with HIV: a review

Bakhla¹,

Saini²

2016

NBHIV

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“…Other studies reported high incident rates of adverse CNS side effects for ritonavir alone; this included insomnia (;70%) and psychologic alterations (24%-30%) (Merry et al, 1996;Nadal et al, 2000). In the RELAX study of 129 HIV patients who had achieved viral suppression and were experiencing CNS side effects severe enough to warrant switching to a different antiretroviral drug, 7% of the patients had been taking ritonavir in combination with either darunavir, atazanavir, or lopinavir (Pedrol et al, 2015).…”

Section: Ritonavirmentioning

confidence: 99%

“…A 5-year retrospective analysis concluded high incidents of various neuropsychiatric side effects (16%-31%), including depression, affective disorders, sleep disorders, and cognitive disorders, with no significant differences between nevirapine and efavirenz (von Giesen et al, 2003). However, the RELAX study suggests that nevirapine is better tolerated with respect to NPAEs than efavirenz (Pedrol et al, 2015).…”

Section: Nevirapinementioning

confidence: 99%

Adverse Neuropsychiatric Events and Recreational Use of Efavirenz and Other HIV-1 Antiretroviral Drugs

et al. 2018

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Efavirenz is a highly effective HIV-1 antiretroviral; however, it is also frequently associated with neuropsychiatric adverse events (NPAE) that include abnormal dreams, sleep disturbances, nervousness, anxiety, depression, and dizziness. The incidence of NPAEs upon initiation of treatment with efavirenz-containing medications is high, exceeding 50% in most studies. Although the NPAEs tend to decrease after the first month in many patients, they persist for long periods of time in others. Efavirenz-based treatment is generally well-tolerated in children, although some experience persistent concentration problems, as well as sleep disturbances, psychotic reactions, and seizures. In an effort to link basic with clinical research, parameters associated with efavirenz brain exposure are discussed, and factors that increase efavirenz levels are explored in depth as they are expected to contribute to NPAE risk. These include the role of modifiable and nonmodifiable risk factors such as diet, weight, and drug-drug interactions and sex, age, and ethnicity/pharmacogenetics. In addition to NPAEs, this review explores what is known about antiretroviral (ARV) drugs being used for recreational purposes. Although multiple ARV drugs are covered, special attention is devoted to efavirenz given that the majority of reports of NPAEs and illicit use of ARV drugs concern efavirenz. The evolving molecular mechanistic basis of NPAEs and abuse of efavirenz point to a complex and polymodal receptor pharmacology. Animal studies to date primarily point to a serotonergic mechanism of action. Recently emerging associations between HIV-associated neurocognitive disorder and efavirenz use, and possible contributions of the mitochondrial-immune-inflammatory-redox cascade are explored in the context of the signaling mechanisms that appear to be involved.

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“…In spite of being one of the safest antiretroviral drugs, patients taking nevirapine develop symptoms such as hallucinations, delusion, mood changes, vivid dreams and depression (Morlese et al 2002; Schaerf et al 1988; Wise et al 2002). A recent study reported that switching to nevirapine from drug regimens that cause neuropsychiatric symptoms (i.e., efavirenz primarily) effectively reduced the occurrence of the psychiatric episodes (Pedrol et al 2015), suggesting that neurotoxicity of nevirapine may be less severe as compared to other drugs used in the study.…”

Section: Classes Of Antiretroviral Drugs: Cns Toxicitymentioning

confidence: 99%

Neurotoxicity in the Post-HAART Era: Caution for the Antiretroviral Therapeutics

et al. 2016

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Despite the advent of highly active antiretroviral therapy (HAART), HIV-associated neurological disorders (HAND) remain a major challenge in human immunodeficiency virus (HIV) treatment. The early implementation of HAART in the infected individuals helps suppress the viral replication in the plasma and other compartments. Several studies also report the beneficial effect of drugs that successfully penetrate central nervous system (CNS). However, recent data in both clinical setup and in in vitro studies indicate CNS toxicity of the antiretrovirals (ARVs). Although the evidence is limited, correlation between prolonged use of ARVs and neurotoxicity strongly suggests that it is essential to study the underlying mechanisms responsible for such toxicity. Furthermore, closer attention toward clinical outcomes is required to screen various ARV regimens for their association with HAND and other comorbidities. A growing body of literature also indicates a possible role of accelerated aging in the antiretroviral therapy-associated neurotoxicity. Lastly, owing to high pill burden, multiple drugs in the HIV treatment also invite a possible role of drug–drug interaction via various cytochrome P450 enzymes. The particular emphasis of this review is to highlight the need to identify alternative approaches in reducing the CNS toxicity of the ARV drugs in HIV-infected individuals.

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Outcome of neuropsychiatric symptoms related to an antiretroviral drug following its substitution by nevirapine: the RELAX study

Cited by 13 publications

References 18 publications

Prevalence, impact, and management of depression and anxiety in patients with HIV: a review

Prevalence, impact, and management of depression and anxiety in patients with HIV: a review

Adverse Neuropsychiatric Events and Recreational Use of Efavirenz and Other HIV-1 Antiretroviral Drugs

Neurotoxicity in the Post-HAART Era: Caution for the Antiretroviral Therapeutics

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