NEW YORK (Reuters Health) – HIV patients whose regimen includes efavirenz and who experience CNS side effects such as insomnia and nervousness may benefit from a switch to etravirine, according to one report in AIDS online November 11, but another paper in the same issue finds the strategy of little benefit.

In the first paper, Dr. Laura Waters, with the Chelsea and Westminster Hospital Foundation Trust in London, UK, and colleagues point out that efavirenz is known to cause neuropsychiatric side effects. They conducted a randomized trial involving 38 men with persistent CNS adverse effects on efavirenz to see if switching from efavirenz to etravirine reduced the rate of grade 2-4 CNS adverse events.

In double-blind fashion, 20 of the men were immediately switched to etravirine for 12 weeks, while the other 18 continued on efavirenz. After 12 weeks, all participants received etravirine in an open-label extension.

The proportion of patients with G2-4 CNS adverse events fell from 90.0% at baseline to 60.0% at 12 weeks in the immediate switch group (p=0.041), while there was a nonsignificant decrease from 88.9% to 81.3% in the delayed switch group. The latter group also saw a reduction in CNS events in the extension phase of the trial.