Brief Report: Late Efavirenz-Induced Ataxia and Encephalopathy: A Case Series

Journal of Acquired Immune Deficiency Syndromes : JAIDS
Ebrahim VariavaNeil A Martinson

Abstract

WHO treatment guidelines recommend efavirenz in first-line antiretroviral therapy (ART). Efavirenz commonly causes early transient neuropsychiatric adverse events. We present 20 cases with severe encephalopathy accompanied by ataxia due to efavirenz toxicity. Consecutive HIV-infected adults taking efavirenz-containing ART admitted to Tshepong hospital, Klerksdorp, South Africa with ataxia and encephalopathy were included in this case series. We identified 20 women admitted to hospital with severe ataxia. All received efavirenz-based ART for a median of 2 years. All had severe ataxia and none had nystagmus. Eleven had features of encephalopathy. Median weight was 34 kg [interquartile range (IQR): 29.7-35.3]; median CD4 count 299 cells/mm (IQR: 258-300) and most (18 of 19) were virally suppressed. Eight patients had a record of prior weights and 7 of 8 showed significant weight loss with a median weight loss of 10.8 kg (IQR: 8-11.6). All cases had plasma efavirenz assays, 19 were supratherapeutic (more than twice the upper level of therapeutic range), and 15 had concentrations above the upper limit of assay detection. Ataxia resolved after withdrawal of efavirenz at a median time of 2 months (IQR: 1.25-4) and recurred in 2 of 3 p...Continue Reading

References

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Citations

Dec 12, 2018·The Journal of Antimicrobial Chemotherapy·Eric H DecloedtGary Maartens
Dec 14, 2018·Scientific Reports·Georgette D KanmogneRobert K Heaton
Oct 27, 2020·Southern African Journal of HIV Medicine·Jeremy NelJoana F Woods
Mar 20, 2020·Neurology. Clinical Practice·Sean G AndersonEric H Decloedt

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