Long term adverse drug reaction to Efavirenz in a HIV infected adolescent

Abstract

Efavirenz is one of the medications used in combined antiretroviral therapy (ART) for the management of HIV infection in adolescents. Various central nervous system adverse reactions have been reported in patients commencing antiretroviral therapy with a regimen containing Efavirenz. These reactions tend to be acute, commonly occurring in the first six months of therapy. Adverse reactions following long term use of Efavirenz for ART is rare among adults and rarer still among children and adolescents. There is only one published case of serious adverse reaction to Efavirenz in an adolescent after long-term use. The case of a male HIV Positive Nigerian patient aged 13 years. He presented with five-day history of Difficulty sleeping, abnormal dreams, inability to concentrate, restlessness, irrational behavior and long-term memory loss. There was no previous history of psychiatric illness and no suggestive social or family history. Patient was on Efavirenz containing regimen about 6.5 years till presentation with adverse reaction mainly affecting behavior, thought processes and memory. After discontinuing Efavirenz and replacing with Nevirapine in his combined ART regimen, all neuropsychiatric manifestations ceased .He regained his memory, no longer had bad dreams or demonstrated any irrational behavior or attitude. Physicians who are involved in the care of HIV infected patients need to be aware of the possibility of adverse Drug reactions occurring in patients who have been on antiretroviral drugs for years. This possibility should not be excluded from possible differential diagnosis.

KEY WORDS: Adolescent; Efavirenz; HIV Infection; Reactions; Adverse drug; Psychomotor Agitation; Long term