For patients with HIV receiving efavirenz-based therapy, sleep and neuropsychological abnormalities do not readily reverse after discontinuation of treatment, according to results published in HIV Clinical Trials.

These results also suggest that obstructive sleep apnea (OSA) may be an underexplored cause of cognitive dysfunction among patients with chronic HIV.

The study included participants with HIV receiving efavirenz, emtricitabine, and tenofovir who did not have traditional risk factors for OSA (n=32). Participants were randomly assigned 2:1 to switch to elvitegravir/cobicistat/emtricitabine/tenofovir or to continue efavirenz, emtricitabine, and tenofovir therapy for 12 weeks. The researchers performed overnight polysomnography and standardized sleep and neuropsychological assessments at baseline and at 12 weeks.

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After 12 weeks, the researchers did not observe any significant differences in change between the 2 treatment groups in terms of any sleep or neuropsychological test parameters.

However, at baseline, the rate of disordered sleep breathing was significantly higher among study participants compared with published age-matched norms. This resulted in a high assessed OSA rate of 59.4%.

The researchers found that respiratory disturbance index, a measure of sleep-disordered breathing, correlated with age- and education-adjusted global neuropsychological Z-score (r=−0.35; P =.05). They also found that sleep maintenance efficiency, wake after sleep onset, rapid eye movement sleep, and respiratory disturbance index correlated with the domain-specific neuropsychological z-score for learning and memory (all P ≤.05).

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“We found…surprisingly high rates of OSA, decreased stage 3 sleep, and increased [rapid eye movement] sleep at entry in this group specifically selected to be without high traditional risk factors for OSA,” the researchers wrote. “Further studies are warranted to define the prevalence, risks, and diagnostic as well as treatment strategies for OSA among individuals with chronic HIV.”


Shikuma CM, Kohorn L, Paul R, et al. Sleep and neuropsychological performance in HIV+ subjects on efavirenz-based therapy and response to switch in therapy. HIV Clin Trials. 2018;19(4):139-147. doi: 10.1080/15284336.2018.1511348