4. 5 Mood changes, anxiety, poor sleep, strange dreams
A couple of HIV meds include mood changes and interrupted sleep as possible side effects.
There are big differences though between these two main examples.
These two drugs are integrase inhibitors that are so similar that their side effects are expected to have a large overlap. They are highly effective as treatment and widely used and recommended as first-line ART in treatment guidelines.
Approximately 1 in 20 people (5%) reported changing treatment due to mood changes, including anxiety, depression and insomnia.
However, insomnia can often easily be overcome by taking ART in the morning rather than the evening. This is the best first advice before changing treatment.
Efavirenz is an NNRTI that for many years was widely recommended as first line ART.
Mood changes and sleep disturbance including bad dreams and nightmares were very commonly reported in nearly everyone who started this treatment. Although these sometimes improved, many people put up with significantly worse quality of life,
Some people get very serious problems – including severe depression and anxiety. In this case, contact the doctor in case it is important to switch to another drug. Efavirenz can make existing worries or depression more serious. You need to be aware of this if you start a combination that includes this drug.
Efavirenz was replaced in treatment guidelines by dolutegravir while has a much lower risk of these side effects. Availablilty of dolutegravir means that no-one should now have to put up with efavirenz side effects.
Further reading
Information about efavirenz side effects from the i-Base guide to side effects and other complications.
Last updated: 1 January 2023.