HIV drug increases risk of suicidal ideation.

A recent study shows an association between Efavirenz (a common anti-HIV drug) and increased risk for suicidal ideation or attempted or completed suicide. The study conducted by Mollan KR et al., and published in Ann Intern Med. 2014 confirmed the neuropsychiatric effects of Efavirenz. With increased life expectancy of people living with HIV infection – and the opportunity to study the long term effects of drugs – the emergence of drug-induced co-morbidities is concerning.

This underscores the need for the development of longer-acting drugs or treatment modalities that limit the constant (daily) use of antiretroviral therapy. Emerging data also beg the question as to the longer-term benefits of immediate treatment of a young individual with normal CD4 T cell count and low viral load.

Indeed, early treatment reduces inflammation and impacts the size of the viral reservoir – yet the clinical benefits are questionable.

One argument for early treatment is epidemiological-based: “to protect the community”. But we probably can dismiss this one because with fashionable PrEP picking up steam we might all be chewing PrEP candies in the near future.

I think more needs to be done to delay the use of antiretroviral drugs wherever possible, and more reliable measures of inflammation are needed so that we are not only guiding treatment based on CD4 cell counts and viral load but also take into account the levels of inflammation a person has. After all, inflammation (which generally is associated with CD4 T cell count) has been shown to be the best predictor of HIV disease progression and mortality.

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Dr Clovis Palmer is a graduate of the University of Sydney, Australia, and holds a PhD in plant biochemistry and molecular genetics. He conducted postdoctoral studies in immunology, liver disease and obesity at the University of New South Wales, Australia.

Dr Palmer is a reviewer for several top-ranked international journals including Hepatology, AIDS and Antioxidants and Redox Signalling. He is the chief scientific editor for Natural Immunity-Health, Australia (www.naturalimmunity.com.au).

 

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Opinions expressed in this article may not reflect those of THEGAYUK, its management or editorial teams. If you'd like to comment or write a comment, opinion or blog piece, please click here.