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

Department of Global Health and Infection, Brighton and Sussex Medical School and Brighton and Sussex University Hospitals NHS Trust, London BN1 9PX, UK
Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, UK
Imperial College London, St Mary’s Campus, London W2 1PG, UK
Guy’s and St Thomas’ NHS Trust, London SE1 7EH, UK
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(8), 195;
Received: 25 June 2019 / Revised: 2 August 2019 / Accepted: 9 August 2019 / Published: 9 August 2019
(This article belongs to the Collection Collection on Clinical Neuroscience)
PDF [414 KB, uploaded 9 August 2019]


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.
Keywords: HIV; efavirenz; rilpivirine; Central nervous system HIV; efavirenz; rilpivirine; Central nervous system
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Vera, J.H.; Bracchi, M.; Alagaratnam, J.; Lwanga, J.; Fox, J.; Winston, A.; Boffito, M.; Nelson, M. Improved Central Nervous System Symptoms in People with HIV without Objective Neuropsychiatric Complaints Switching from Efavirenz to Rilpivirine Containing cART. Brain Sci. 2019, 9, 195.

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