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More than half of all patients who begin efavirenz-based antiretroviral therapy (ART) experience immediate neuropsychiatric adverse effects. Some patients cannot tolerate these symptoms and stop the treatment immediately; for those who remain on efavirenz-based therapy, conventional wisdom holds that the symptoms will eventually abate. However, studies now indicate that even patients on long-term efavirenz may report persistent, subtle adverse effects from the drug, and other patients are not even aware of ongoing problems (JW AIDS Clin Care May 16 2011).
In a 4-week, double-blind, crossover trial partially funded by the maker of raltegravir, 53 adults on stable, fully suppressive efavirenz-based ART (median duration, 3.4 years) substituted …