Prevalence of central nervous system adverse effect and associated factors among HIV patients on efavirenz based ART regimen

Background: Efavirenz based antiretroviral regimens served as a first line treatment in our country, however commonly lead to central nervous system toxicity, which is the main reason for non-adherence, switch and discontinuation to antiretroviral therapy. We aimed to assess prevalence of central nervous system adverse effect and associated factors among HIV patients taking efavirenz based regimens. Methods: Hospital based cross-sectional study was conducted on 345 patients who were taking efavirenz based ART medications on follow up at UoGCSH from March 15 to may15, 2018. Information on socio-demographic characteristics and detailed history regarding central nervous system adverse effect were taken from both the patient and medical record.. Both bivariate and multivariate analyses were done using binary logistic regression to find out the associated factors. Level of statistical significance was declared at P value of ≤ 0.05 levels. Result: The central nervous system adverse effects of EFV based ART regimen were observed in 52.8% of participants and vivid dream was the most commonly reported adverse effect. Upon computation of bivariate binary logistic regression economic status, EFV based regimen type, Stage of RVI, alcohol use and concomitant medical condition had shown association on the occurrence of central nervous system adverse effect of EFV based ART regimen. But in multivariate analysis alcohol use (p = 0.004; AOR = 4.450), stage I RVI (p = 0.001; AOR= 0.006) stage II RVI (p = 0.001; AOR=0.017) stage III RVI (P=0.01; AOR=4.13) became significantly associated with the occurrence of CNS adverse effect. Conclusion: More than half of HIV patients taking efavirenz based regimens at UOGCSH experience the central nervous system adverse effect. The most commonly reported central nervous system adverse effects were vivid dream, confusion, and insomnia. Stage III and IV HIV patient need special attention to prevent and decrease central nervous system adverse effect of EFV based regimen. Health workers need to tell the patients to avoid alcohol, especially in the initiation of the treatment.