Abstract
BackgroundEfavirenz is associated with neuropsychiatric side effects. The consequences of using efavirenz in human immunodeficiency virus (HIV)-positive patients with mental illness has not been conclusively established, the concern being that efavirenz may worsen the condition of an already mentally ill patient. The absence of guidelines and the lack of evidence for the use of efavirenz in this special population lead to uncertainty and, as a result, varying practices in the clinical settingAimTo determine the experiences of healthcare professionals caring for mentally ill people living with HIV (PLWH) who are using efavirenz, the associated neuropsychiatric side effects and the management thereof.SettingEastern Cape, South Africa.MethodA qualitative, descriptive, exploratory design was used to understand the phenomenon under study and to share the experiences of the participants. Semi-structured interviews were conducted. The data were analysed using thematic framework analysis and coded by the researcher as well as an independent coder.ResultsThere were conflicting feelings concerning the use of efavirenz in PLWH with active mental illnesses. Some healthcare professionals were willing to prescribe and use efavirenz whilst others were not. All participants indicated that further elucidation in the guidelines on the possible side effects associated with efavirenz and suggested management strategies would be useful.ConclusionThe expansion of the South African National Guidelines for the Treatment of HIV should include descriptions of the side effects caused by antiretrovirals and management strategies thereof to empower healthcare professionals to make informed decisions regarding patient care for mentally ill PLWH.
Highlights
Human immunodeficiency virus (HIV) is an infection that spreads through bodily fluids such as semen, blood, preseminal fluid, rectal fluid, vaginal fluids and breast milk (WHO 2016)
Human immunodeficiency virus cannot be cured, but there are several classes of antiretrovirals (ARVs) used in the management of people living with HIV (PLWH) of which non-nucleoside reverse transcriptase inhibitors are one
The study sought to determine the experiences of healthcare professionals caring for PLWH who are mental health users prescribed and given efavirenz and its associated neuropsychiatric side effects and the management thereof
Summary
Human immunodeficiency virus (HIV) is an infection that spreads through bodily fluids such as semen, blood, preseminal fluid, rectal fluid, vaginal fluids and breast milk (WHO 2016). Human immunodeficiency virus cannot be cured, but there are several classes of antiretrovirals (ARVs) used in the management of people living with HIV (PLWH) of which non-nucleoside reverse transcriptase inhibitors are one. Efavirenz together with nevirapine form part of this group of ARVs (Rossiter 2012:339). In 2008 in South Africa, the prevalence of HIV was 16.9% in people between the ages of 15 and 49 years (Freeman et al 2008:490). For the same age group, 15–49 years, 16.6% were HIV-positive (Statistics SA 2015:1). The consequences of using efavirenz in human immunodeficiency virus (HIV)-positive patients with mental illness has not been conclusively established, the concern being that efavirenz may worsen the condition of an already mentally ill patient. The absence of guidelines and the lack of evidence for the use of efavirenz in this special population lead to uncertainty and, as a result, varying practices in the clinical setting
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