Some anti-HIV drugs can affect your emotional and mental
health. Most notably, the non-nucleoside reverse transcriptase inhibitor
(NNRTI) efavirenz (Sustiva, also in the combination pill, Atripla) has been associated with
depression and sleeplessness, as well as vivid dreams.
Some doctors think that the depression that some people
develop when taking efavirenz is actually a recurrence of pre-existing
depressive symptoms; people with a history of depression may be more likely to
become depressed again when they start taking efavirenz. It is important you
tell staff at your HIV clinic if you have a history of depression, before you
start HIV treatment. If you do have previous experience of mental health problems,
efavirenz might not be a good choice for you. You can talk to your doctor about
other treatment options.
Often the emotional troubles and sleep problems associated
with efavirenz lessen or go away completely within a few weeks of starting this
treatment. But for some people they become a long-term side-effect.
Research suggests that such side-effects are more likely to
happen if you have a particular gene that creates higher levels of efavirenz in
the blood. It’s possible to test blood levels of efavirenz and, if these are
too high, it might be possible to reduce your dose. But you shouldn’t try and
do this by yourself. Talk to your HIV clinic about these or any other
side-effects that are causing you concern.
If you find that you cannot cope with the problems
efavirenz can cause, there are likely to be other equally effective treatment
options available to you. Ask your clinic staff for advice on these.
Anti-HIV drugs can also affect your emotional wellbeing by
causing side-effects such as pain, nausea and vomiting, or diarrhoea. Most
side-effects are generally mild and lessen or go away over time. Furthermore,
it’s nearly always possible to do something about side-effects. There are now
over 20 anti-HIV drugs available, and it’s often possible to change to a drug
that doesn’t cause the side-effect you find problematic.
Some older anti-HIV drugs can cause changes in body shape
through fat loss or fat gain (a condition called lipodystrophy). Although the
use of these drugs is now avoided as much as possible, changes in body shape
can lead to loss of self-confidence and self-esteem. If you have these
feelings, ask at your clinic to see a counsellor or psychologist to discuss
them. You can also raise this issue with your HIV doctor to find out what can be
done to stop, or reverse, these body shape changes.
You can find out more about side-effects and how to avoid
or deal with them in the booklet in this series, Side-effects.
Some drugs used to treat other infections that are common
in people living with HIV can also cause mental health problems.
Interferon and pegylated interferon treatments for
hepatitis C virus, which many people living with HIV are co-infected with, can
cause emotional distress and depression.
If you need to take these drugs, your doctor may also
arrange some psychological therapy or prescribe you antidepressants,
particularly if you have a prior history of depression. It is important that
you discuss this with your healthcare team if this is the case. For more
information, see the booklet HIV &
hepatitis in this series.