From the Guidelines
HIV antiretroviral medications can cause memory issues in some patients, particularly those with certain antiretroviral drugs that cross the blood-brain barrier, such as efavirenz. The most recent and highest quality study, published in 2023 1, suggests that while HIV itself can cause cognitive problems, the medications used to treat it can also have an impact on cognitive function. Some antiretroviral drugs, such as efavirenz, have been associated with neuropsychiatric side effects including memory problems, confusion, and difficulty concentrating, as they can affect neurotransmitter levels in the brain or cause mild inflammation in neural tissue 1. Other medications like dolutegravir and some protease inhibitors may also cause milder cognitive effects in some individuals. Key points to consider include:
- The cognitive effects of antiretroviral medications can improve with time as the body adjusts to the medication
- In some cases, switching to an alternative drug may be necessary to minimize side effects
- Untreated HIV itself can cause more severe cognitive problems than the medications, so maintaining treatment is crucial
- If experiencing memory issues while on HIV medication, it is essential to discuss these symptoms with a healthcare provider rather than stopping treatment, as they can adjust the regimen to minimize these side effects.
From the FDA Drug Label
5.6 Nervous System Symptoms Fifty-three percent (531/1008) of patients receiving efavirenz in controlled trials reported central nervous system symptoms (any grade, regardless of causality) compared to 25% (156/635) of patients receiving control regimens [see Adverse Reactions (6.1, Table 3)]. These symptoms included, but were not limited to, dizziness (28.1% of the 1008 patients), insomnia (16. 3%), impaired concentration (8.3%), somnolence (7.0%), abnormal dreams (6.2%), and hallucinations (1.2%). Late-onset neurotoxicity, including ataxia and encephalopathy (impaired consciousness, confusion, psychomotor slowing, psychosis, delirium), may occur months to years after beginning efavirenz therapy
Memory issues can be related to the use of efavirenz, as impaired concentration is reported in 8.3% of patients. Additionally, late-onset neurotoxicity may include symptoms such as impaired consciousness and confusion, which can affect memory. However, the direct relationship between efavirenz and memory issues is not explicitly stated. 2
From the Research
HIV Retroviral Medications and Memory Issues
- The relationship between HIV retroviral medications and memory issues is complex, with some studies suggesting a link between the two 3, 4, 5, 6, 7.
- Research has shown that people living with HIV may experience memory impairment, despite the use of antiretroviral therapy (ART) 3, 5.
- The central executive component of working memory has been consistently reported to be impaired in HIV infection, while other components of memory, such as the phonological loop and visuospatial sketchpad, appear to be unimpaired 3.
- Some studies have found an association between HIV infection and verbal and visual episodic memory, although the results are discordant 3.
- There is little evidence to suggest that semantic memory is affected by HIV infection, although the neural substrate of implicit memory may be damaged by the effects of HIV infection and inflammation 3.
- The use of certain antiretroviral drugs, such as efavirenz, has been associated with neuropsychiatric complications, including cognitive impairment and sleep disturbance 7.
- The development of antiretroviral therapy has dramatically increased the lifespan of HIV patients, but treatment is complicated by numerous adverse effects and toxicities, including neuropsychiatric effects 7.
- Clinicians must carefully consider the potential neuropsychiatric consequences of ART when tailoring treatment to individual patients 7.