Efavirenz is a commonly prescribed drug for the treatment of children with HIV but it may cause neuropsychiatric adverse events. The authors were interested in comparing the competence (social involvement, activities and school performance) and psychopathology (internalising and externalising problems), cognitive performance (intelligence and working memory), and adherence in Tanzanian children on an efavirenz-based versus a non-efavirenz-based regimen. They conducted a cross-sectional, observational study in which consecutive children aged 6-12 years with HIV infection, on antiretroviral therapy (ART) for at least 6 months and with viral loads <1000 copies/mL from Kilimanjaro, Tanzania were recruited. Children with acute illnesses, medication switches during the previous 6 months and any history of brain injury or developmental delay before ART initiation were excluded. 141 children were examined, of which 51% were on efavirenz-based and 49% were on non-efavirenz-based ART. After controlling for age, sex, and clinical and demographic factors, the authors observed significantly lower competence (adjusted mean difference -2·43, 95%CI -4·19 to -0·67), largely driven by significantly lower school performance scores (adjusted mean difference -0·91, 95%CI -1·42 to -0·40), in the efavirenz group than in the non-efavirenz group. Differences in total and internalising behavioural problems were non-significant. No differences were found in externalising problems. Therefore treatment with efavirenz in children is associated with a mild increase in neuropsychiatric symptoms, particularly for children who receive doses higher than or equal to the WHO recommended dose.
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