期刊
AIDS
卷 23, 期 11, 页码 1359-1366出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0b013e32832c4152
关键词
antiretroviral therapy; cerebrospinal fluid; cognition; HIV; neuropsychological tests
资金
- NCRR NIH HHS [5-MO1 RR00044, RR00046, RR-00052, M01 RR000096, M01 RR000044, M01 RR000046, M01 RR000052, M01RR00096] Funding Source: Medline
- NIAID NIH HHS [AI34853, U01 AI069501, U01 AI068636-01, AI -69532, AI69501, U01 AI069511, U01 AI069415, U01 AI034853, UM1 AI069474, AI 69415, P30 AI027757, 5-P30-AI-045008-07, AI69511, U01 AI069432, UM1 AI069415, AI69474, AI69471, U01 AI069495, UM1 AI069432, U01 AI069465, AI 69434, U01 AI038858, P30 AI045008, UM1 AI069471, UM1 AI069434, U01 AI038858-07, UM1 AI069465, UM1 AI069495, AI-38858, AI50410, UM1 AI069511, U01AI068636, AI69472, AI69432, UM1 AI069467, AI69467, U01 AI068636, U01 AI069471, U01 AI069467, UM1 AI069472, UM1 AI069423, UM1 AI069501, AI38858, U01 AI069474, AI69423, U01 AI069423, AI-69465, U01 AI069472, P30 AI050410, AI-27757, AI69495, U01 AI069434] Funding Source: Medline
- NINDS NIH HHS [U01 NS032228, NS32228, R01 NS032228] Funding Source: Medline
Objective: To determine whether antiretroviral regimens with good central nervous system (CNS) penetration control HIV in cerebrospinal fluid (CSF) and improve cognition. Design: Multisite longitudinal observational study. Setting: Research clinics. Study participants: One hundred and one individuals with advanced HIV beginning or changing a new potent antiretroviral regimen were enrolled in the study. Data for 79 participants were analyzed. Participants underwent structured history and neurological examination, venipuncture, lumbar puncture, and neuropsychological tests at entry, 24, and 52 weeks. Intervention: Antiretroviral regimens were categorized as CNS penetration effectiveness (CPE) rank of at least 2 or less than 2. Generalized estimating equations were used to examine associations over the course of the study. Main outcome measures: Concentration of HIV RNA in CSF and blood and neuropsychological test scores (NPZ4 and NPZ8). Results: Odds of suppression of CSF HIV RNA were higher when CPE rank was at least 2 than when it was less than 2. Odds of suppression of plasma HIV RNA were not associated with CPE rank. Among participants with impaired neuropsychological performance at entry, those prescribed regimens with a CPE rank of at least 2 or more antiretrovirals had lower composite NPZ4 scores over the course of the study. Conclusion: Antiretroviral regimens with good CNS penetration, as assessed by CPE rank, are more effective in controlling CSF (and presumably CNS) viral replication than regimens with poorer penetration. In this study, antiretrovirals with good CNS penetration were associated with poorer neurocognitive performance. A larger controlled trial is required before any conclusions regarding the influence of specific antiretrovirals on neurocognitive performance should be made. (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
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