Efavirenz is related to neuropsychiatric symptoms among adults, but not among adolescents living with HIV in Kilimanjaro, Tanzania

Marion Sumari-de Boer, Arnt Schellekens, Ashanti Duinmaijer, Julieth Munisi Lalashowi, Happiness Judical Swai, Quirijn de Mast, Andre van der Ven, Grace Kinabo
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To explore the relationship between Efavirenz (EFV) and neuropsychiatric symptoms among adults and adolescents living with HIV in Kilimanjaro, Tanzania.


Cross-sectional study among HIV-infected adults (age 18-65) and adolescents (age 12-17) on ART, attending Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania. Neuropsychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS), the Symptom Checklist 90 (SCL-90) and the Mini-International Neuropsychiatric Interview (MINI). MANOVA and χ2-tests were used to test differences between EFV and non-EFV treated participants.


215 adults and 150 adolescents participated. 52% of adults and adolescents 37%of adolescents used EFV. Among adults, depression scores were higher for those on EFV (HADS (Cohen's D: 0.38; p=0.02) and SCL-90 (Cohen's D: 0.24; p=0.03). Among adolescents, those on EFV had lower scores on depression (HADS (Cohen's D: 0.3;p=0.02) and SCL-90 (Cohen's D: 0.1;p=0.02). 10% of adults reported suicidal thoughts, but there was no difference between those on EFV and those without. Lastly, adults on efavirenz reported higher levels of problematic alcohol use (p=0.003).


In line with previous studies, EFV is associated with depressive symptoms and problematic alcohol use among HIV-infected adults in Tanzania. In contrast, EFV was associated with lower levels of depressive symptoms in adolescents in Tanzania. Particularly among adults, close monitoring of depressive symptoms and alcohol use is indicated.