1. Neurocognitive impairment in patients randomized to second-line lopinavir/ritonavir-based antiretroviral therapy vs. lopinavir/ritonavir monotherapy.
- Author
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Bunupuradah T, Chetchotisakd P, Jirajariyavej S, Valcour V, Bowonwattanuwong C, Munsakul W, Klinbuayaem V, Prasithsirikul W, Sophonphan J, Mahanontharit A, Hirschel B, Bhakeecheep S, Ruxrungtham K, and Ananworanich J
- Subjects
- Adenine analogs & derivatives, Adenine pharmacology, Adenine therapeutic use, Adult, CD4 Lymphocyte Count, Cognition Disorders etiology, Cognition Disorders virology, Depression etiology, Depression virology, Female, HIV Infections complications, HIV Infections psychology, HIV Infections virology, HIV Protease Inhibitors pharmacology, HIV-1 physiology, Humans, Lamivudine pharmacology, Lamivudine therapeutic use, Lopinavir pharmacology, Lopinavir therapeutic use, Male, Organophosphonates pharmacology, Organophosphonates therapeutic use, RNA, Viral blood, RNA, Viral cerebrospinal fluid, Reverse Transcriptase Inhibitors pharmacology, Ritonavir pharmacology, Ritonavir therapeutic use, Tenofovir, Viral Load drug effects, Cognition Disorders psychology, Depression psychology, HIV Infections drug therapy, HIV Protease Inhibitors therapeutic use, HIV-1 drug effects, Reverse Transcriptase Inhibitors therapeutic use
- Abstract
We compared rates of neurocognitive impairment (NCI) among 93 Thai adults failing non-nucleoside reverse transcriptase inhibitor (NNRTI)-based combination antiretroviral therapy (cART) before and after switching to lopinavir/ritonavir monotherapy (mLPV/r) vs. tenofovir/lamivudine/LPV/r (TDF/3TC/LPV/r). Participants completed the Color Trails 1 and 2, Digit Symbol, and Grooved Pegboard at weeks 0, 24, and 48. We calculated z-scores using normative data from 451 healthy HIV-negative Thais. We defined NCI as performance of <-1 SD on ≥2 tests. The Thai depression inventory was used to capture depressive symptoms. Lumbar puncture was optional at week 0 and 48. At baseline, median (IQR) age was 36.9 (32.8-40.5) years, and 46 % had primary school education or lower. The median CD4 count was 196 (107-292) cells/mm(3), and plasma HIV RNA was 4.1 (3.6-4.5) log(10) copies/ml. Almost all (97 %) had circulating recombinant CRF01_AE. At baseline, 20 (47 %) of the mLPV/r vs. 22 (44 %) of TDF/3TC/LPV/r arms met NCI criteria (p = 0.89). The frequency of NCI at week 48 was 30 vs. 32 % (p = 0.85) with 6 vs. 7 % (p = 0.85) developing NCI in the mLPV/r vs. TDF/3TC/LPV/r arms, respectively. Having NCI at baseline and lower education each predicted NCI at week 48. Depression scores at week 48 did not differ between arms (p = 0.47). Cerebrospinal fluid HIV RNA of <50 copies/ml at 48 weeks was observed in five out of seven in mLPV/r vs. three out of four in TDF/3TC/LPV/r arm. The rates of NCI and depression did not differ among cases failing NNRTI-based cART who received mLPV/r compared to LPV/r triple therapy.
- Published
- 2012
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