Improved Central Nervous System Symptoms in People with HIV without Objective Neuropsychiatric Complaints Switching from Efavirenz to Rilpivirine Containing cART

Vera Vera,Lwanga Lwanga,Fox Fox,Boffito Boffito,Winston Winston,Alagaratnam Alagaratnam,Nelson Nelson,Bracchi Bracchi

doi:10.3390/brainsci9080195

Abstract

Objective: Occult central nervous system (CNS) symptoms not recognized by people living with HIV (PLWH) receiving efavirenz or their clinicians could occur and impact people’s quality of life. The aim of this study was to determine whether CNS parameters improve in PLWH when switching from efavirenz to rilpivirine. Methods: PLWH receiving tenofovir disoproxil fumarate, emtricitabine, efavirenz (Atripla™) with undetectable HIV RNA, and no CNS symptoms were switched cART to tenofovir disoproxil fumarate, emtricitabine, rilpivirine (Eviplera™). CNS parameters including sleep, anxiety, and depressive symptoms were evaluated using patient-reported outcome measures at baseline, 4, 12, and 24 weeks after switching therapy. A median CNS score was derived from the sum of CNS toxicities of all the grades collected in the study questionnaires. Cognitive function was assessed using a computerized test battery. Results: Of 41 participants, median age was 47 years, Interquartile range (IQR) 31, 92% were male and 80% were of white ethnicity. A significant reduction in total CNS score (10 to 7) was observed at 4 weeks (p = 0.028), but not thereafter. Significant improvements in sleep and anxiety were observed 4, 12 and 24 weeks after switching therapy (p < 0.05). No significant change in global cognitive scores was observed. Conclusions: Switching from efavirenz to rilpivirine based regimens in virologically suppressed PLWH without perceived CNS symptoms was well tolerated and slightly improved overall CNS symptoms.

Highlights

Antiretroviral toxicity is a common cause for therapy modification with around a quarter of individuals on first-line combination antiretroviral therapy changing treatment due to the onset of toxicity including central nervous system (CNS) toxicity [1,2]
This study suggests that switching efavirenz to rilpivirine containing combination antiretroviral therapy (cART) in virologically suppressed people with HIV without perceived objective CNS toxicity slightly improves neuropsychiatric symptoms, cognitive function and health-related quality of life, but does not improve overall CNS cognitive function
We found that sleep quality and nervousness that were not perceived as side effects of efavirenz were significantly better up to 24 weeks after switching to rilpivirine

Summary

Introduction

Antiretroviral toxicity is a common cause for therapy modification with around a quarter of individuals on first-line combination antiretroviral therapy (cART) changing treatment due to the onset of toxicity including central nervous system (CNS) toxicity [1,2]. Switching from efavirenz-containing regimes to efavirenz free cART has been associated with improved CNS toxicity in several studies [8,11,12,13]. Hakkers et al recently reported a randomized controlled trial where an improvement in cognitive function after switching from efavirenz to rilpivirine based cART was observed in asymptomatic patients on effective cART [16]. Another randomized controlled trial of people with HIV on efavirenz switching to rilpivirine did not show a significant improvement in cognitive function or patient reported outcomes of depression and anxiety [17]

Methods

Results

Discussion

Conclusion