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Efavirenz CNS Effects — RACP Adult Medicine MCQ

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HardInfectious DiseasesEfavirenz CNS EffectsRACP Adult Medicine

A patient with suppressed HIV develops persistent vivid dreams, dizziness and impaired concentration after starting efavirenz. What is the best management approach?

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Correct answer: AReview interactions and adherence, then change to a better-tolerated effective antiretroviral regimen with the HIV team

The best answer is “Review interactions and adherence, then change to a better-tolerated effective antiretroviral regimen with the HIV team”. Efavirenz is well recognised to cause central nervous system adverse effects. Persistent function-limiting toxicity justifies a planned switch that preserves virological suppression and accounts for resistance, interactions and hepatitis status. Unstructured interruption risks rebound and resistance; sedative polypharmacy or unvalidated underdosing treats neither the cause nor HIV safely.

Reference: ASHM: National HIV testing policy and clinical resources: https://testingportal.ashm.org.au/national-hiv-testing-policy/