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Neuropsychological changes in efavirenz switch regimens

Li, Yijiaa; Wang, Zhengb; Cheng, Yub,c; Becker, James T.c; Martin, Eileend; Levine, Andrewe; Rubin, Leah H.f; Sacktor, Nedf; Ragin, Anng; Ho, Kena,h

doi: 10.1097/QAD.0000000000002206

Background: Efavirenz is associated with side effects involving the central nervous system. However, it remains largely unknown whether switching off EFV improves neuropsychological performance.

Methods: We utilized data from the Multicenter AIDS Cohort Study (MACS). Participants were categorized by their use of EFV: never on EFV (No EFV), continuously on EFV (No Switch-OFF) and on EFV and then switched off (Switch-OFF). Baseline time points were defined as visits when first neuropsychological data were available. In Analysis 1, we compared neuropsychological and Center for Epidemiological Studies-Depression Scale (CES-D) scores before and after EFV switch in Switch-OFF group, aligning participants at the time of switch. Analysis 2 evaluated trajectory of neuropsychological/CES-D score among the three groups.

Results: This analysis included 1989 HIV-seropositive participants with neuropsychological data (1675 in No EFV, 44 in No Switch-OFF, and 270 in Switch-OFF group). At baseline, participants had a median age of 37 years, median CD4+ cell count 442 cells/μl, and 22.9% viral suppression rate. In Analysis 1, neuropsychological and CES-D scores did not show clinically significant changes over 2 years prior to and 4 years after switch in Switch-OFF group. In Analysis 2, trends in neuropsychological and CES-D scores in the three different groups did not show significant differences during a median of 3.2 years of follow-up.

Conclusion: Discontinuation of EFV is not associated with changes in neuropsychological performance or severity of depression in men. Furthermore, we did not observe differences among participants who were never on EFV, continuously on EFV, and on EFV and then switched off.

aUniversity of Pittsburgh School of Medicine

bDepartment of Statistics

cDepartment of Psychiatry, University of Pittsburgh, Pittsburgh

dRush University School of Medicine, Chicago

eDepartment of Neurology, UCLA - David Geffen School of Medicine, Los Angeles

fDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore

gFeinberg School of Medicine, Northwestern University, Chicago

hDivision of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, USA.

Correspondence to Dr Ken Ho, Falk Medical Building, 3601 Fifth Avenue, Suite 3A, Pittsburgh, PA 15213, USA. Tel: +1 412 383 1675; fax: +1 412 647 7951; e-mail:

Received 18 November, 2018

Revised 15 February, 2019

Accepted 18 February, 2019

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