Treatment with efavirenz (Sustiva) does not appear to increase the risk of depression for HIV-positive patients coinfected with hepatitis C virus who are receiving hepatitis C therapy, Spanish researchers report in the September 1st edition of the Journal of Acquired Immune Deficiency Syndromes.
But the researchers did find that treatment with efavirenz increased the risk of mood disorders in coinfected patients receiving anti-hepatitis C drugs.
Many patients with HIV are also coinfected with hepatitis C virus. The current standard of care for hepatitis C infection is pegylated interferon with ribavirin. This treatment clears infection with hepatitis C in approximately 66% of coinfected patients who receive treatment soon after they are infected with hepatitis C and in about a third of coinfected patients who have chronic hepatitis C infection.
Pegylated interferon can cause significant side-effects, including symptoms of depression, headache and insomnia. Such symptoms, as well as other neuropsychiatric side-effects, can also be caused by efavirenz, a drug used for first-line HIV therapy.
Researchers in Madrid wanted to determine the safety of pegylated interferon in patients taking efavirenz. They therefore looked at the medical records of 266 HIV-positive patients coinfected with hepatitis C virus who received hepatitis C treatment between 1999 and 2006. A total of 53 (20%) of these patients were also receiving treatment with efavirenz. The researchers compared rates of neuropsychiatric side-effects in the efavirenz-treated patients and those seen in patients who did not receive therapy with this drug.
There was a high incidence of neuropsychiatric side-effects, and the investigators noted that there was a trend just short of statistical significance for a higher risk of such side-effects amongst the efavirenz-treated patients (79% vs 65%, p = 0.051). Mood disorders, such as sadness and apathy were significantly more common amongst the patients treated with efavirenz (36% vs 23%, p = 0.046). However, although efavirenz-treated patients were more likely to have received treatment with antidepressants (23% vs 16%), the difference was not statistically significant.
The investigators found no statistically significant difference in the rate of anxiety, insomnia, irritability, headache, and use of drugs for anxiety or sleeping tablets between the patients treated with efavirenz and those not receiving this drug.
When the investigators restricted their analysis to patients with cirrhosis, they found that patients treated with efavirenz were slightly less likely to report neuropsychiatric side-effects (70% vs 85%, p = 0.2). Furthermore, patients taking efavirenz were less likely to report insomnia (15% vs 55%).
Few patients stopped treatment because of side-effects, and the risk of this was not increased by treatment with efavirenz.
The investigators conclude, “although concomitant efavirenz use may favour symptoms of mood disorder, it was not related to an increased risk of significant depression requiring treatment.”
Quereda C et al. Effect of treatment with efavirenz on neuropsychiatric adverse events of interferon in HIV/HCV-coinfected patients J Acquir Immune Defic Synr 49: 61 – 62, 2008.