| Publication Abstract Display | | Type: Published Manuscript | | Title: Enhancing antiretroviral therapy for Human Immunodeficiency Virus cognitive disorders. | | Authors: Letendre SL, McCutchan JA, Childers ME, Woods SP, Lazzaretto D, Heaton RK, Grant I, Ellis RJ, and the HNRC Group | | Contact: HIV Neurobehavioral Research Center, University of California at San Diego, San Diego, CA 92103, USA. | | Year: 2004 | | Publication: Annals of Neurology | | Volume: 56 Issue: 3 Pages: 416-23 | | Abstract:The benefits of combination antiretroviral therapy (ART) for HIV cognitive disorders vary substantially between individuals. This study evaluated whether cerebrospinal fluid (CSF) drug penetration and CSF virological suppression influence the extent of neuropsychological (NP) improvement during ART. Overall performance on a battery of NP tests administered at baseline and follow-up (median 15 weeks) was computed by using the global deficit score (GDS) methods in 31 cognitively impaired, HIV-infected individuals who began new ART regimens. Virological suppression (attaining undetectable viral load by RT-PCR at follow-up) was assessed separately for plasma and CSF. Subjects on regimens containing greater numbers of CSF-penetrating drugs showed significantly greater reduction in CSF viral load. Subjects attaining CSF virological suppression demonstrated greater GDS improvement than those who did not (median GDS change, 0.62 vs 0.23; p = 0.01). A similar trend for plasma did not reach statistical significance (p = 0.053). NP improvement was greater in ART-naive versus treatment-experienced subjects. In a multivariate model (overall p = 0.0008), significant, independent predictors of GDS reduction were CSF HIV RNA suppression, baseline antiretroviral history, and their interaction. Including CSF-penetrating drugs in the ART regimen and monitoring CSF viral load may be indicated for individuals with HIV-associated cognitive impairment. | | Funding: NIMH:MH K23 MH01779, NIMH:MH P30 MH62512, NIMH:MH R01 MH58076 | | Keywords: Adult, Anti-Retroviral Agents, Chi-Square Distribution, Cognition Disorders, Comparative Study, Female, HIV Infections, HIV-1, Humans, Male, Middle Aged, Multivariate Analysis, Neuropsychological Tests, Prospective Studies, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S., Statistics, Nonparametric |
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