Reply to Gonzalez and Everall: Lest we forget: neuropsychiatry and the new generation anti-HIV drugs

In their review about neuropsychiatric disorders and the new generation of anti-HIV drugs, Gonzalez and Everall [1] refrain from mentioning the neuropsychiatric side-effects of efavirenz. These central nervous system (CNS) symptoms occur relatively frequently and include: dizziness, headache, confusion, stupor, agitation, amnesia, depersonalization, euphoria, hallucinations, insomnia, abnormal dreaming, anxiety, depression and suicide ideation [2,3].

CNS symptoms may appear after the first dose and may resolve spontaneously after a few days or weeks. Certain minor CNS symptoms, such as dizziness, can be avoided by taking the drug at bedtime. Patients who complain of nightmares while taking the usual 600 mg dose at bedtime can be advised to switch to a twice a day regimen.

In the presence of serious neuropsychiatric side-effects such as anxiety, depression and suicide ideation switching to another antiretroviral drug may be needed.