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No association found between efavirenz, suicide risk

Contrary to previous findings, individuals with HIV treated with efavirenz demonstrated no increased risk for suicidal ideation or depression, according to new research published in Annals of Internal Medicine.

“Evidence regarding potential adverse neuropsychiatric effects of efavirenz is conflicting, and data from sub-Saharan Africa, where 70% of persons living with HIV reside and efavirenz is used as first-line therapy, are limited,” Jonathan L. Chang, MPH, from Duke University School of Medicine and Massachusetts General Hospital, and colleagues wrote.

Chang and colleagues conducted a prospective observational cohort study to identify the association between efavirenz use and depression and suicidal ideation among individuals with HIV living in Uganda (n = 694; median age, 33 years; median pretreatment CD4+ count = 1.8 × 10⁹ cells/L). A total of 694 participants initiating antiretroviral therapy were enrolled in the study and observed for psychiatric symptoms every 3 to 4 months for 10 years.

At baseline, patients ever exposed to efavirenz (n = 305) and those never exposed to efavirenz and receiving nevirapine (n = 389) showed similar prevalence of depression and suicidal ideation.

The researchers found that during at least one follow-up visit, 20% of participants ever-exposed to efavirenz had depression and 6.2% had suicidal ideation, compared with 32.1% and 12.1% of those who received nevirapine, respectively.

Adjusted models showed that participants using efavirenz were less likely to have depression that those using nevirapine (adjusted OR = 0.62; 95% CI, 0.4-0.96). Additionally, there was no significant association between efavirenz use and suicidal ideation (aOR = 0.61; 95% CI, 0.3-1.25).

These findings contradict previous studies that have found that efavirenz increases the risk for suicidal behavior.

“We believe our study is the first to detect a statistically significant, unexpected inverse association between efavirenz use and depression,” Chang and colleagues concluded. “These data offer preliminary evidence of possible regional differences in efavirenz tolerability. Further work is needed to confirm these results, establish consistency in other subpopulations, and elucidate possible genetic or environmental factors that might account for regional differences in efavirenz tolerability.” – by Alaina Tedesco

Disclosure: Chang reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.