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Neuropsychiatric Effects of HIV Antiviral Medications

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Abstract

The development of antiretroviral therapy (ART) has dramatically increased the lifespan of HIV patients but treatment is complicated by numerous adverse effects and toxicities. ART complications include neuropsychiatric, metabolic, gastrointestinal, cardiac, and numerous other toxicities, and clinicians often have to choose one toxicity over another to offer the best medication regimen for a patient. Some antiviral drugs cause significant neuropsychiatric complications, including depression, cognitive impairment, and sleep disturbance. Even in careful studies, it may be difficult to determine which effects are related to the virus, the immune system, or the treatment. Of the six currently marketed classes of antiviral drugs, the nucleoside reverse transcriptase inhibitors and the non-nucleoside reverse transcriptase inhibitors have been most commonly associated with neuropsychiatric complications. Within these classes, certain drugs are more likely to cause difficulty than others. We review the contention regarding the central nervous system (CNS) complications of efavirenz, as well as debate about the role of CNS penetration in drug effectiveness and toxicity. A thorough working knowledge of the neuropsychiatric consequences of ART allows clinicians to tailor treatment more successfully to individual patients as well as to identify ART more quickly as the source of a problem or symptom.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, USA

    Glenn J. Treisman & Olivia Soudry

  2. Department of Medicine, Meyer 119 Johns Hopkins Hospital, Baltimore, 21287, USA

    Glenn J. Treisman & Olivia Soudry

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  1. Glenn J. Treisman
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Correspondence to Glenn J. Treisman.

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Our clinical work is supported in part by Ryan White funds; however, none of these funds went towards the writing of this paper.

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Glenn J. Treisman and Olivia Soudry have no conflicts of interest that are directly relevant to the content of this review.

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Treisman, G.J., Soudry, O. Neuropsychiatric Effects of HIV Antiviral Medications. Drug Saf 39, 945–957 (2016). https://doi.org/10.1007/s40264-016-0440-y

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