Recurrence of post-traumatic stress disorder symptoms after initiation of antiretrovirals including efavirenz: A report of two cases

Background. Some antiretrovirals has been reported to cause a wide range of psychiatric symptoms. However, reappearance of post-traumatic stress disorder (PTSD) symptoms has not been described in relation to these medications. Design. Case report. Settings. The Boston Medical Center, a tertiary care academic centre. Findings. Two HIV-infected refugees re-experienced symptoms of PTSD after starting therapy with efavirenz (EFV) and zidovudine (ZDV). The two patients had no typical factors present to account for the PTSD exacerbation. In both patients, the symptoms of PTSD gradually subsided to baseline within the first 4 weeks of antiretroviral treatment. Conclusions. We believe that EFV, a non-nucleoside reverse transcriptase inhibitor, with ZDV, may be manifesting its known neuropsychiatric toxicities in a heretofore unreported presentation of PTSD exacerbation.