Acute psychosis under efavirenz in a HIV patient


Haifa Zalila
hend Elloumi
Nesrine Gaha
Rim Ghachem
Imen Ghazali
Afif Boussetta


Background: Efavirenz is one of the most prescribed HIV drugs, it can have number of psychiatric adverse effects varying from sleeping disorders to psychotic symptoms.
Aim : Through a case-report study we tried to evaluate the imputability of an acute psychosis to Efavirenz.
Case: Mr. B is 25-year-old, he had hemophilia A, he has been infected by HIV and HVC during one of the transfusion sessions. He’d had Combined therapy, component of Epivir, Zerit and Efavirenz. Three months after Efavirenz’s prescription he presented a schizophreniform disorder according to DSM IV criteria.
Discussion: The onset of psychotic manifestations, 3 months after prescription is not in favor of drug’s etiology. Neuropsychiatric side effects generally appear rapidly after the first dose and usually decrease during the first four months. Psychotic disorders are generally rare. However those side effects have been reported 03 years after drug introduction.
Conclusion: Such information has an impact on drug prescription. In fact, efavirenz had been stopped, although the improvement of CD4 and the difficulty to prove the imputability of psychotic syndrome to efavirenz.


Acute psychosis, HIV, Efavirenz, Imputability



  1. Gulick RM. Antiretroviral management of treatment naive patients. Infectious Disease Clinics of North America 2007;21:71-84.
  2. Staszewcski S, Morales-Ramirez J, Tashima KT, Rachlis A, Skiest D, Stanford J, and al. Efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. N Engl J Med 1999;341:1865-73.
  3. Vray M, Meynard JL, Dalban C, Morand-Joubert L, Brun-Vezinet F, Clavel F, and al. Predictors of the virological response to a change in the antiretroviral treatment regimen in HIV-1-infected patients enrolled in a randomized trial comparing genotyping, phenotyping and standard of care (Narval trial, ANRS 088). Antivir Ther 2003;8:427-34.
  4. Lochet P, Peyriere H, Lotthe A, Mauboussin JM, Delmas B, Reynes J. Long-term assessment of neuropsychitric adverse reactions associated with efavirenz. HIV Med 2003; 41: 62-6.
  5. Rouanet J. Efavirenz effects worse than reported, study says, AIDS Alert 2003;18: 9-10.
  6. De Ronchi D, Faranca I, Forti P, Ravaglia G, Borderi M, Manfredi R, and al. Development of acute psychotic disorders and HIV-1 infection. Int J Psychiatry Med 2000; 30(2):173-83.
  7. Bary M, David F, Gasnault J, Kerneis H, Linard F, Longuet P, Pelissolo A, Ravaux I. Troubles neuropsychiatriques chez les patients infectés par le VIH et rôle de l'efavirenz. Médecine et maladies infectieuses 2004; 34:435-449.