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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 17, Suppl D, Pages 10D-14D

General Management Strategies for Efavirenz Therapy and Associated Adverse Events

Jean-Guy Baril1 and Anita Rachlis2

1Clinique Médicale du Quartier Latin and Service-Consultation-Liaison VIH/SIDA, CHUM (University of Montreal Hospital Centre), Montreal, Quebec, Canada
2Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

Copyright © 2006 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Efavirenz therapy-related central nervous system symptoms often occur shortly after initiation of treatment; therefore, the timing of therapy initiation must be carefully considered so that if side effects do occur, it is at a time when the patient is not mentally overburdened and when support is readily available. Current literature contains contradictory data on the relationship between plasma levels of efavirenz and the occurrence of neuropsychiatric adverse events; therefore, routine measurement of plasma concentrations is not recommended except under certain circumstances. Clinician management of general neuropsychiatric symptoms comprises four steps: preparation, education, reassurance and treatment. Among the specific central nervous system symptoms that are known to occur with efavirenz therapy are agitation, sleep disturbances, dreams, dizziness, impaired concentration and depression. There are recommended pharmacological and nonpharmacological protocols for managing these symptoms. Prompt, successful management of treatment-emergent neuropsychiatric symptoms is important so that the patient may receive the optimal longterm viral suppression that is possible with efavirenz therapy.