The association between depression and efavirenz-based antiretroviral treatment in people living with human immune-deficiency virus: a systematic review

The neuropsychiatric disturbance such as depression in people living with (PLHIV) requires serious attention as this affects their health outcome. Efavirenz (EFV)-based treatment has been associated with neuropsychiatric adverse events, but its mechanism still unknown. The purpose of this systematic review is to dissect recent studies regarding EFV and depression, in the hope to discover reasonings behind this association. PRISMA flow chart was used to search for the related literatures in the last five years (2018-2023). Targeted population was PLHIV on EFV-based ART only and/or compared with non-EFV-based ART. Relevant keywords used to search were HIV, efavirenz and depression. Five eligible articles were selected which included a total of 3272 PLHIV. Overall, three studies agreed that EFV-based ART was related to depression, while the other two studies did not. It was shown that EFV-based ART did cause neuropsychiatric adverse effects in the first few weeks of treatment, but subsided after several months. However, longer-term research is needed to determine its long-term effects. Variation of results in different studies must be influenced by the possible genetic factors, baseline depression, different social and psychological circumstances throughout the treatment and different assessment tools for depression. Depression on EFV-based treatment in PLHIV may manifest in the initial few weeks of treatment, and additional research is still needed to determine its effects throughout longer treatment durations. Early diagnosis of depression in PLHIV is essential to decide the best choice of ARV for better outcome.