Canadian Expert Panel Recommendations on the Management of CNS Symptoms Related to Efavirenz

Efavirenz is a potent antiretroviral agent used in combination with other antiretroviral agents as part of highly activeantiretroviral therapy. Efavirenz is generally well tolerated because the majority of its adverse effects are self-limiting,with central nervous symptoms and rash being the most frequent. In routine practice, the discontinuation rateof efavirenz due to adverse effects appears higher than that described in clinical trials. To minimize early treatmentinterruption and maximize the benefit of long term viral suppression that can be achieved with efavirenz therapy,health care providers and patients have identified that there is a need for information, education about and practicaltools for the management of efavirenz-related side effects. To this end, a panel of experts in the care of HIVpatients consisting of primary care physicians, infectious disease specialists, psychiatrists and pharmacists was convened.Through the evaluation of current literature and discussion among the group, the panel arrived at consensusrecommendations. The present report outlines general management recommendations that apply to adverse effectsrelated to efavirenz initiation, as well as specific management strategies for central nervous system symptoms suchas agitation, sleep disturbances, dreams, dizziness, impaired concentration and depression. It is hoped that thesepractical recommendations will aid clinicians in minimizing and improving patient tolerance of side effects, therebyachieving improved adherence and patient outcomes