Switch from Efavirenz to Nevirapine Associated with Resolution of Efavirenz-Related Neuropsychiatric Adverse Events and Improvement in Lipid Profiles

In a large HIV-specialty private practice, patients with undetectable or low-grade–positive viral loads with neuropsychiatric side effects or elevated lipids were switched from efavirenzto nevirapine-based antiretroviral regimens. This is a retrospective analysis of virologic efficacy and changes in adverse neuropsychiatric effects and serum lipid levels after this switch. Forty patients were evaluated. Thirty-six had undetectable viral loads prior to the treatment switch, and their levels remained undetectable after the switch for a median of 25 months(range, 6 to 59 months). Four patients had persistently low-grade–positive viral loads before the switch; viral loads in two of the four patients remained low-grade–positive, while the levels in two patients became undetectable. Twenty patients reporting neuropsychiatric symptoms(depression, anxiety, or fatigue with or without sleep disturbances) before the switch demonstrated significant improvement, with complete resolution of symptoms in 15 patients. Four patients with isolated sleep disturbances had significant improvement. No rash developed in any patient during the switch. Mean lipid levels improved significantly following the switch. Mean total cholesterol decreased 17.8 mg/dL; low-density lipoprotein cholesterol decreased 25.5 mg/dL; triglycerides decreased 70.1 mg/dL; and high-density lipoprotein cholesterol increased 5.3 mg/dL (all p < 0.05). These results demonstrate that patients who are virologically controlled on efavirenz-containing regimens with treatment-associated side effects can be successfully switched to nevirapine-containing therapy with maintenance of virologic control, reduction in neuropsychiatric side effects, and improvement in dyslipidemia.