Central Nervous System Side Effects from HIV Treatment

One class of HIV medicines has been associated with problems related to the central nervous system. Side effects include vivid dreams and sleep problems. Learn how to manage these side effects.

Participants:
Graeme Moyle, MBBS, MD
Associate Director of HIV Research, Chelsea and Westminster Hospital
Peter Reiss, MD, PhD
Associate Professor of Medicine, University of Amsterdam

Webcast Transcript

ANNOUNCER: HIV medications have a wide range of side effects. Ones that affect the central nervous system can be especially disturbing.

WINSTON BATCHELOR: I've had weird dreams where I'm being chased by zombies. I've saving Captain Kirk and Spock from the Borg and I get assimilated and I die. All these weird things where I'm losing the battle, not winning the battle. So that's kind of, to me, the very scary thing.

ANNOUNCER: Winston Batchelor is 34 years old. He's been HIV positive since he was 19. Winston has been on antiretroviral therapy for seven years, and over that period, various drugs have made him feel nauseous, exhausted and lightheaded. When Winston switched regimens, and went on Sustiva in 1998, he experienced the strange dreams.

GRAEME MOYLE, MD: The most common thing that comes on with the first dose of medication and then tends to fade over the course of the next two or three weeks are sleep disturbances where people get more vivid dreams or remember their dreams more clearly over the course of the evening.

ANNOUNCER: Sustiva is a commonly-used anti-HIV drug, in a class of medications called non-nucleoside reverse transcriptase inhibitors.

There are reports that other drugs in this class have also caused central nervous system side effects. But they're more common with Sustiva.

As they should with any drug, doctors discuss Sustiva's side effects, especially sleep disturbances, with their patients.

PETER REISS, MD: It's common in patients who you put on efavirenz. But in the majority of patients, it's transient. So it's something that you need to forewarn them about. You need to tell them before you put them on that this may appear. This is what it may look like, that they shouldn't be surprised, that they shouldn't get scared and try to talk them through.

ANNOUNCER: Sleep disturbances are not the only central nervous system side effects with Sustiva.

GRAEME MOYLE, MD: Some people feel that they have a dizziness where they've not really got the spins, but they just feel as though they're a little perhaps intoxicated by the medication.

ANNOUNCER: That's exactly how Winston felt the first time he took the drug.

WINSTON BATCHELOR: About an hour, hour and a half later, I got up out of the chair and it was like someone had drugged or given me a bottle of wine. I felt so inebriated, I just fell back into the chair and my world started spinning and everything started moving.

ANNOUNCER: Other, less common, side effects with some of the non-nucleoside medicines include headache, impaired concentration, and depression. To help patients manage the side effects associated with Sustiva, doctors prescribe taking the drug at a time-of-day when the side effects may be the most tolerable.

PETER REISS, MD: It's usually given at night, efavirenz, so before bedtime, because the perception is that it may bother people less if they take it at night and the problem sets in when they may already be asleep. ANNOUNCER: Doctors say that for most patients, the best advice is: Stick with the drug, and wait out any problem with side effects.

GRAEME MOYLE, MD: In general, the average time that these effects last is around three to four weeks so we usually advise people that once you're through that first month of dosing, you'll probably find that either those effects have completely gone or they've diminished to a point that they're not noticeable. There is a small proportion of people, perhaps five to ten percent who get episodes of dreaming that last for a lot longer than that and perhaps persist with the medication for a longer period of time. But it rarely leads to those people discontinuing their medication.

ANNOUNCER: For help with sleep problems, doctors have other suggestions.

GRAEME MOYLE, MD: A lot of the patients report that the content of their dreams may relate to their activities of daily living, their job and those sorts of things. So trying to avoid thinking negative things in the late evening so don't watch the news, don't watch a horror movie, may help avoid having negative experiences as part of the dreams.

ANNOUNCER: Still other management strategies include avoiding heavy meals at nighttime, and taking other medications, including sleeping pills.

Despite the side effects with Sustiva, Winston says his HIV is under control.

WINSTON BATCHELOR: My recent test, about two weeks ago, like I said, my viral load's down. I think it was down to 64, the count was down to 64, so it was pretty good. And my T-cells are up to about 650 or 630, the highest it's been in the past two years. So the doctors are very happy about that.

ANNOUNCER: The effectiveness of Sustiva, in combination with other medicines, is one reason to stick with the regimen.

WINSTON BATCHELOR: Here I am 13 years later, and I'm still alive, thank God. So I just count every day. Even though I get sick and I come out of it, I always count every day.