For years the association of a life-saving medicine commonly used in first-line antiretroviral treatment regimens with psychiatric side effects that included thoughts of suicide, posed an urgent question to HIV physicians administering care across Africa. Risks of depression among people living with HIV already are higher than among those of the general population and threaten treatment outcomes, the authors of a report in the Annals of Internal Medicine note. But while data from four clinical trial group studies linking increased incidence of suicidal thoughts and actions with the use of efavirenz had prompted the U.S. Department of Health and Human Services to drop the medicine from its list of first recommended treatment options, with little information on the impacts of the drug on Africa, the continent that is home to 70 percent of people worldwide living with HIV, the World Health Organization continued to recommend the drug among those used first to treat the virus.
With unexpected findings, the study, from data collected in a rural Uganda trial, filled some of the gap. Collecting data on efavirenz use as well as on measures of depression, including thoughts of suicide from nearly 700 participants between 2005 and 2015, researchers found what they call “compelling data” that not only was the drug a safe option for first-line therapy in the region, but was associated with a significantly lowered risk of depression.
Offering potential evidence of regional differences in how the drug is tolerated, the authors, led by Jonathan Chang of Duke University School of Medicine, write, their study appears to be the first to yield indications reversing the more commonly perceived relationship between efavirenz and psychiatric side effects. More data is needed, they add, both to confirm and expand their findings and to identify genetic or environmental factors that may contribute to regional differences in the drug’s effects.