Hawkins Trevor, Geist Cindy, Young Ben, Giblin A, Mercier Renee C, Thornton Karla, Haubrich Richard
Southwest CARE Center, Santa Fe, New Mexico 87505, USA.
HIV Clin Trials. 2005 Jul-Aug;6(4):187-96. doi: 10.1310/92vr-fp24-j8ga-b49q.
To compare the extent of neuropsychiatric disturbances in two similar groups of HIV-infected patients treated for >4 weeks with either efavirenz (EFV) or protease inhibitors (PIs) as part of their antiretroviral therapy (ART).
A cross-sectional, questionnaire-based cohort of HIV patients who received two nucleoside reverse transcriptase inhibitors combined with either EFV (n = 75) or one or more PIs (n = 77) for at least 4 weeks and were tolerating therapy. The extent of neuropsychiatric disturbances was evaluated based on self-reported symptoms using the psychological evaluation test SCL-90-R. Treatment duration was broken down into quartiles of 30-198 days, >198-365 days, >365-637 days, and >637 days.
In the first 6 months of therapy, significantly higher (worse) scores were seen in 39/75 (52%) of the patients receiving EFV. The EFV-treated group had significantly higher scores for somatization, anxiety, obsessive-compulsive behavior, the Global Severity Index, and the Positive Symptom Distress Index, with trends for higher scores in paranoid ideation and depression symptom subcategories. Over the following 6 to 12 months of therapy, the EFV group scored higher than the PI group in somatization, anxiety, obsessive-compulsive behavior, hostility, depression, the Global Severity Index, and the Positive Symptom Total, but the differences were not significant. After 12 months of therapy, the EFV group had significantly lower scores than the PI group for somatization, interpersonal sensitivity, Global Severity Index, and Positive Symptom Total.
EFV-induced neuropsychiatric symptoms can last up to 200 days after treatment initiation. However, symptom severity appears to decline over time in EFV-treated patients versus patients treated with a PI-based ART.
比较两组接受抗逆转录病毒治疗（ART）超过4周的相似HIV感染患者中，使用依非韦伦（EFV）或蛋白酶抑制剂（PIs）治疗时神经精神障碍的程度。
一项基于问卷调查的横断面队列研究，纳入接受两种核苷类逆转录酶抑制剂联合EFV（n = 75）或一种或多种PIs（n = 77）治疗至少4周且耐受治疗的HIV患者。使用心理评估测试SCL-90-R根据自我报告症状评估神经精神障碍的程度。治疗持续时间分为30 - 198天、>198 - 365天、>365 - 637天和>637天四个四分位数区间。
在治疗的前6个月，接受EFV治疗的39/75（52%）患者出现显著更高（更差）的评分。接受EFV治疗的组在躯体化、焦虑、强迫行为、总体严重程度指数和阳性症状苦恼指数方面得分显著更高，在偏执观念和抑郁症状亚类中有得分更高的趋势。在接下来治疗的6至12个月中，EFV组在躯体化、焦虑、强迫行为、敌对、抑郁、总体严重程度指数和阳性症状总分方面得分高于PI组，但差异不显著。治疗12个月后，EFV组在躯体化、人际敏感、总体严重程度指数和阳性症状总分方面的得分显著低于PI组。
EFV诱导的神经精神症状在治疗开始后可持续长达200天。然而，与接受基于PI的ART治疗的患者相比，EFV治疗患者的症状严重程度似乎随时间下降。
