University of Pittsburgh School of Medicine.
Department of Statistics.
AIDS. 2019 Jul 1;33(8):1307-1314. doi: 10.1097/QAD.0000000000002206.
Efavirenz is associated with side effects involving the central nervous system. However, it remains largely unknown whether switching off EFV improves neuropsychological performance.
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.
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.
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.
依非韦伦会引起中枢神经系统相关的副作用。然而，目前尚不清楚停用依非韦伦是否会改善神经心理学表现。
我们利用了多中心艾滋病队列研究（MACS）的数据。参与者根据其使用依非韦伦的情况进行分类：从未使用过依非韦伦（无依非韦伦组）、持续使用依非韦伦（未停药组）和使用过依非韦伦后停药（停药组）。基线时间点定义为首次获得神经心理学数据的访视。在分析 1 中，我们比较了停药组中停药前后的神经心理学和流行病学研究中心抑郁量表（CES-D）评分，并在停药时对参与者进行了匹配。分析 2 评估了三组中神经心理学/CES-D 评分的轨迹。
本分析纳入了 1989 名有神经心理学数据的 HIV 阳性参与者（无依非韦伦组 1675 名，未停药组 44 名，停药组 270 名）。基线时，参与者的中位年龄为 37 岁，中位 CD4 细胞计数为 442 个/μl，病毒抑制率为 22.9%。在分析 1 中，停药组在停药前 2 年和停药后 4 年内，神经心理学和 CES-D 评分没有显示出临床上有意义的变化。在分析 2 中，在中位 3.2 年的随访期间，三组参与者的神经心理学和 CES-D 评分趋势没有显示出显著差异。
男性中，停用依非韦伦与神经心理学表现或抑郁严重程度的变化无关。此外，我们没有观察到从未使用过依非韦伦、持续使用依非韦伦和使用过依非韦伦后停药的参与者之间存在差异。
