Abacavir (ZiagenTM) may have psychosis as a very rare side-effect, according to a case report published in the April edition of the journal HIV Medicine.
This is the first report of abacavir as a possible cause of psychosis, although psychosis has been associated with other anti-HIV drugs, including AZT and efavirenz.
Doctors at the Maudsley Hospital in south London had a highly educated 37 year old Ugandan woman referred to them with symptoms of psychosis, a month after starting a HAART regimen consisting of nevirapine, Combivir and abacavir. On referral to the mental health specialists the woman’s CD4 cell count was over 300 cells/mm3 and viral load a little over 700 copies/mL. The woman had given birth to a baby eleven months before presentation and had had her HIV infection diagnosed during pregnancy.
The woman had no history of depression or previous psychiatric disorders and tests revealed that there was no underlying physical cause for the psychosis.
On admission to hospital, the woman attempted to harm her baby and later became catatonic. HAART was stopped and low-dose anti-psychotic medication was prescribed.
The woman’s mental health quickly stabilised, however her CD4 cell count fell to a little over 120 cell/mm3, although her viral load remained stable.
HAART was recommenced, consisting of nevirapine and Combivir, with no recurrence of psychosis after one year of follow-up. Although there have been several case reports of AZT causing psychosis, the inclusion of the drug in the woman’s second HAART regimen and her subsequent stable mental health appeared to rule out AZT as the cause.
As abacavir was the only drug in the intitial HAART regimen which was not included in the second combination and the lack of other apparent causes of psychosis, the investigators suggest that abacavir was the probable cause of the psychosis. This is the first time such a side-effect has been recorded for the drug.
The investigators suggest antiretrovirals should be considered as a possible cause of psychosis in patients developing the condition for the first time after commencing HAART.
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Foster R et al. Antiretroviral therapy-induced psychosis: case report and brief review of the literature. HIV Medicine 4: 139 – 144, 2003.