A review of trials investigating efavirenz-induced neuropsychiatric side effects and the implications.

Efavirenz is part of the first-line treatment for HIV patients including those in South Africa with approximately 50% experiencing neuropsychiatric side effects. A systematic review of papers reporting neuropsychiatric side effects with efavirenz published between January 2001 and December 2014 was performed, to provide guidance. 13 articles were reviewed. Patient ages ranged between 37 to 41 years, with a high percentage males. Scales used to measure incidence and severity of side effects were varied; with disease severity or stage not reported. Patients with psychoses were excluded. Most commonly reported side effects were a reduction in sleep quality, depression, dizziness and anxiety. These were generally mild and not warranting discontinuation of efavirenz. It is difficult to directly compare the studies. Standardised methods need to be introduced and all patient groups represented including the elderly, children, patients with active symptomatic illness and more women especially among the African population.

Cytotoxicity of recent dentin bonding agents on mouse fibroblast cells.

OBJECTIVES: To compare the cytotoxicity of the polymerized bonding agents Scotchbond 1 (3M ESPE), Prime and Bond NT (Dentsply DeTrey), Xeno III (Dentsply DeTrey), and Clearfil Protect Bond (primer and bond parts; Kuraray) on mouse fibroblast cells. Xeno III was also tested through thin dentin disks. METHOD AND MATERIALS: Near-confluent 3T3 cells were exposed to Dulbecco modified eagle's medium extractions from the above-mentioned agents, and the cell viability (survival rate) was measured using the standard MTT assay and related to the nonexposed controls. RESULTS: All bonding agents were found to be cytotoxic toward the 3T3 cells. Scotchbond 1 (59% survival rate) and Prime and Bond NT (62% survival rate) were not statistically different (Kruskal-Wallis test, P> > .05). However, the survival rates of Xeno III (25% through membrane and dentin disks) and Clearfil Protect Bond (35%) were significantly lower than those of the other 2 bonding agents, with Xeno III significantly the most toxic (Kruskal-Wallis test, P> .05). Of the 2 parts from Clearfil Protect Bond, the bond part was the least toxic (91% survival rate), but the primer part was very toxic (30% survival rate). CONCLUSION: In an in vitro culture, all 4 dentin bonding agents were cytotoxic. Xeno III was the most toxic, even through dentin disks. It seems that the cytotoxicities depend on the compositions of the materials tested. The most toxic part of Clearfil Protect Bond was the primer, which contains the antibacterial pyridinium molecule.