- DTG may cause insomnia, headache and neuropsychiatric side-effects.
- AZT and RAL frequently cause headaches when started but this usually resolves.
- The majority of patients who experience neuropsychiatric features of EFV do so within the first 2–6 weeks, and thereafter the drug is better tolerated. Late neurological syndromes are described however (see Module 4).
- Most neuropsychiatric effects relating to ART occur in the first few weeks of therapy.
- Depression and other mental illnesses are often undiagnosed or undertreated in HIV-infected individuals and may undermine adherence.
- Consider avoiding EFV- and RPV- based regimens in patients with psychiatric illness – these drugs can exacerbate psychiatric symptoms and may be associated with suicidality.
Mental health, especially mood and behaviour disorder, is associated with non-adherence to ART, leading to disability and poorer HIV treatment outcomes. There is a higher prevalence of depression in HIV-positive individuals, with a reported range of 20–40% vs. 10% in the general population.89
AZT and RAL frequently cause headaches when started, but this usually resolves. EFV frequently causes neuropsychiatric effects in the first few weeks of therapy, typically presenting with insomnia, vivid dreams and dizziness. Both dysphoria and euphoria may occur. Fortunately, these features subside in the majority of patients within the first 4–6 weeks. Psychosis may occasionally occur. DTG may cause insomnia, headache and neuropsychiatric side-effects. RAL has been associated with similar central nervous system side-effects.
|Common pitfall: Not warning patients starting ART about potential neuropsychiatric symptoms. Patients must be informed about potential side-effects.|
|Common pitfall: Unnecessary delays in initiating ART in patients with psychiatric illness.|