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Abstract
Effect of intermittent versus continuous exposure to efavirenz on depressive symptoms in HIV-infected adults in West Africa (Trivacan ANRS 1269 trial)
F. Marcellin1, R. Moh2, M.P. Carrieri1, C. Danel2, C. Protopopescu1, D. Gabillard2, B. Spire1, X. Anglaret2
Background: Efavirenz (EFV) has been clearly shown to induce sleep disturbances, dizziness and anxiety. Its suspected association with depression has been poorly documented so far.
Methods: The Trivacan trial was conducted in Côte d’Ivoire between 2002 and 2007. ART-naive adults received antiretroviral treatment (ART) for 6 to 18 months and were randomized into three strategies: continuous treatment (CT), 2-months-off/4-months-on treatment (2Mo4MO) and CD4-guided treatment. The CD4-guided strategy was interrupted prematurely. In May-June 2006, a cross sectional study of depressive symptoms was conducted in patients followed-up on EFV in the CT and 2Mo4MO arms. Variables of the Centre for Epidemiologic Studies Depression (CES-D) scale were recorded during face-to-face interviews. A depression score (range 0-60) was calculated. Patients scoring >16 were considered as depressive. Logistic regression was used to test the association between depression and treatment strategy, adjusting for exposure to EFV (months on EFV, excluding time off ART in the 2Mo4MO arm) and other individual characteristics.
Results: 248 patients (CT: 77, 2Mo4MO: 171) on EFV were included in the survey. Their mean exposure to EFV was 34.7 months in CT and 26.1 in 2Mo4MO. The percentage of patients with depression was 36.4% in CT and 29.8% in 2Mo4MO. In multivariate analysis the risk of depression was independently associated with the strategy (CT vs 2Mo4MO: OR[95%CI] 2.88[1.16-7.14]), exposure to EFV (for +1 month: 0.91[0.85-0.98]) and mean number of self-reported symptoms per month since randomisation (1.22[1.06-1.42]). CD4 count, gender, age, education level and time since HIV diagnosis were not significantly associated with depression.
Conclusions: In these African patients exposed to EFV for about 3 years, the risk of depression decreased with duration of exposure but depressive symptoms remained frequent. Intermittent exposure to EFV was independently associated with a lower risk of depression, illustrating the direct link between EFV and depression.
AIDS 2008 - XVII International AIDS Conference
Abstract no.
THPE0187
Suggested Citation
"F.Marcellin, et al.
Effect of intermittent versus continuous exposure to efavirenz on depressive symptoms in HIV-infected adults in West Africa (Trivacan ANRS 1269 trial).
:
AIDS 2008 - XVII International AIDS Conference:
Abstract no.
THPE0187"
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