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13 - References

References

Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 A 2023 systematic review concluded that dolutegravir-­based regimens led to higher discontinuation rates due to neuropsychiatric adverse effects compared with those treated with bictegravir, emtricitabine and tenofovir alafenamide. Antiretroviral ­regimen choice should evidently take into account the individual’s risk factors for ­developing neuropsychiatric adverse effects.46 References

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  15. Lesko CR, et al. Depression and HIV viral nonsuppression among people engaged in HIV care in an urban clinic, 2014–2019. AIDS 2021; 35:2017–2024. Table 10.2  (Continued ) Drug Adverse psychiatric effects/comments Etravirine Sleep disturbance Nevirapine Visual hallucinations, persecutory delusions, mood changes, nightmares and vivid dreams, depression. A handful of cases have been reported. Onset of symptoms was within the first couple of weeks. Symptoms all resolved on discontinuation of nevirapine. Rilpivirine Depression, suicidality, sleep disturbances. A similar adverse effect profile to efavirenz but a lower incidence of each event. May exacerbate psychiatric symptoms; consider avoiding in patients with a history of psychiatric illness. Integrase strand transfer inhibitors Dolutegravir, elvitegravir, raltegravir Insomnia, depression, suicidal ideation (particularly with dolutegravir and symptoms may appear within first months of treatment) Bictegravir Depression incidence similar to dolutegravir (though suicidality greater for dolutegravir) but further data required Cabotegravir Limited data but incidence appears low – also long acting and so effects may be prolonged

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