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Article Synopsis
  • Efavirenz (EFV) can cause severe neuropsychiatric symptoms, but the specific clinical signs and risk factors are not clearly defined, prompting this study aimed at improving recognition of such neurotoxicity by clinicians.
  • Researchers analyzed data from 81 patients in Cape Town with high EFV levels, finding that 62 experienced neuropsychiatric issues, primarily ataxia and psychomotor slowing, and 19 had liver problems.
  • The study identified that longer EFV use, higher drug concentrations, and concurrent isoniazid exposure significantly increased the risk of severe neurotoxicity, though symptoms often resolved within a month of stopping EFV treatment.
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Background: Many drugs used for the treatment of HIV disease can cause drug hypersensitivity reactions. Since 2002, World Health Organization (WHO) has recommended the use of nevirapine and efavirenz as part of first line antiretroviral therapies for several years. Both of the drugs had equivalent clinical efficacy but differences in toxicity profile.

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Non-nucleoside reverse transcriptase inhibitor (NNRTI) associated rash is common and frequently leads to discontinuation of NNRTIs. This study assessed the risk of developing rashes and discontinuing NNRTIs and associated factors in a large clinic in central Ghana. In this retrospective cohort study, clinical data were obtained in patients starting efavirenz or nevirapine between 2004-2010.

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Efavirenz-associated QT prolongation and Torsade de Pointes arrhythmia.

Ann Pharmacother

June 2002

Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.

Objective: To report a case of acquired long QT syndrome that, after exclusion of all other possible causes, was probably related to therapy with efavirenz, a novel nonnucleoside reverse transcriptase inhibitor.

Case Summary: This patient presented with recurrent syncope and polymorphic ventricular tachycardia, which was treated with overdrive ventricular pacing and was eliminated by discontinuation of the offending drug.

Discussion: This is the first reported case of QT prolongation and severe ventricular arrhythmia associated with the use of efavirenz.

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