Sodium valproate and highly active antiretroviral therapy in HIV positive patients who develop new onset seizures

Recurrent seizures may occur in up to 11% of HIV positive patients. The aetiology of the seizures includes opportunistic infections, neoplasia, HIV itself, metabolic derangements and drugs. Apart from treating the cause of the seizures, the challenge is to use the appropriate anticonvulsant drug (AED) to avoid potentially adverse drug-drug interactions in patients who are on concurrent highly active antiretroviral therapy (HAART). Initial recommendations were that the newer AEDs should preferably be used because of their simpler pharmacokinetics. We report on our experience with the use sodium valproate (SV) in eight patients who were on concurrent HAART. There were two males and six females with a mean age of 34.1 years. The mean dose of SV was 1075 mg per day. Seizure control was excellent, the CD4 count improved and there was successful viral suppression in all patients. This small study showed that SV was safe and effective. It is also relatively inexpensive compared to the newer AEDs - an important consideration in resource poor settings.