HIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes

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dc.contributor.authorCross, Helen M
dc.contributor.authorCombrinck, Marc I
dc.contributor.authorJoska, John A
dc.date.accessioned2021-10-08T07:18:05Z
dc.date.available2021-10-08T07:18:05Z
dc.date.issued2013
dc.description.abstractABSTRACT BACKGROUND: The human immunodeficiency virus (HIV) can give rise to a spectrum of neuropsychological impairments known collectively as HIV-associated neurocognitive disorders (HAND). Although antiretroviral therapy (ART) has reduced the incidence of HIV dementia, the prevalence of milder forms of HAND has increased. It has been postulated that incomplete central nervous system (CNS) viral suppression or potential drug toxicity, both of which could be related to the CNS penetration effectiveness (CPE) of ART regimens, may contribute to this phenomenon. OBJECTIVE: This study compared cognitive outcomes in clade C-infected HIV patients in South Africa treated for 1 year with ART regimens with differing CPE scores. METHODS: We assessed 111 HIV-positive patients with varying levels of cognitive function at baseline (pre-ART) and then a year later. A neuropsychological battery was administered at both visits to derive global deficit scores. ART regimen data were collected at the follow-up visit. Some participants remained ART-naïve during this period, thus providing a non-treatment control group. RESULTS: Significantly more ART recipients maintained or improved cognitive function compared with patients not on ART (p=0.017). There was no significant difference in cognitive outcomes between higher and lower CPE regimen groups (p=0.473). CONCLUSIONS: ART preserves or improves cognition in HIV-infected patients after 1 year, irrespective of the regimen's CPE. South Africa's current low CPE-scored first-line regimen performed as well as higher CPE-scored regimens. These findings are reassuring for South Africa, but larger, longer-term studies would be more definitive.
dc.identifier.apacitationCross, H. M., Combrinck, M. I., & Joska, J. A. (2013). HIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes. <i>South African Medical Journal</i>, 103(10), 758 - 177. http://hdl.handle.net/11427/34901en_ZA
dc.identifier.chicagocitationCross, Helen M, Marc I Combrinck, and John A Joska "HIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes." <i>South African Medical Journal</i> 103, 10. (2013): 758 - 177. http://hdl.handle.net/11427/34901en_ZA
dc.identifier.citationCross, H.M., Combrinck, M.I. & Joska, J.A. 2013. HIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes. <i>South African Medical Journal.</i> 103(10):758 - 177. http://hdl.handle.net/11427/34901en_ZA
dc.identifier.issn0038-2469
dc.identifier.ris TY - Journal Article AU - Cross, Helen M AU - Combrinck, Marc I AU - Joska, John A AB - ABSTRACT BACKGROUND: The human immunodeficiency virus (HIV) can give rise to a spectrum of neuropsychological impairments known collectively as HIV-associated neurocognitive disorders (HAND). Although antiretroviral therapy (ART) has reduced the incidence of HIV dementia, the prevalence of milder forms of HAND has increased. It has been postulated that incomplete central nervous system (CNS) viral suppression or potential drug toxicity, both of which could be related to the CNS penetration effectiveness (CPE) of ART regimens, may contribute to this phenomenon. OBJECTIVE: This study compared cognitive outcomes in clade C-infected HIV patients in South Africa treated for 1 year with ART regimens with differing CPE scores. METHODS: We assessed 111 HIV-positive patients with varying levels of cognitive function at baseline (pre-ART) and then a year later. A neuropsychological battery was administered at both visits to derive global deficit scores. ART regimen data were collected at the follow-up visit. Some participants remained ART-naïve during this period, thus providing a non-treatment control group. RESULTS: Significantly more ART recipients maintained or improved cognitive function compared with patients not on ART (p=0.017). There was no significant difference in cognitive outcomes between higher and lower CPE regimen groups (p=0.473). CONCLUSIONS: ART preserves or improves cognition in HIV-infected patients after 1 year, irrespective of the regimen's CPE. South Africa's current low CPE-scored first-line regimen performed as well as higher CPE-scored regimens. These findings are reassuring for South Africa, but larger, longer-term studies would be more definitive. DA - 2013 DB - OpenUCT DP - University of Cape Town IS - 10 J1 - South African Medical Journal LK - https://open.uct.ac.za PY - 2013 SM - 0038-2469 T1 - HIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes TI - HIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes UR - http://hdl.handle.net/11427/34901 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34901
dc.identifier.vancouvercitationCross HM, Combrinck MI, Joska JA. HIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes. South African Medical Journal. 2013;103(10):758 - 177. http://hdl.handle.net/11427/34901.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceSouth African Medical Journal
dc.source.journalissue10
dc.source.journalvolume103
dc.source.pagination758 - 177
dc.source.urihttps://dx.doi.org/10.7196/SAMJ.6677
dc.subject.otherAnti-Retroviral Agents
dc.subject.otherCentral Nervous System
dc.subject.otherCognition
dc.subject.otherCognition Disorders
dc.subject.otherFollow-Up Studies
dc.subject.otherHIV Infections
dc.subject.otherHumans
dc.subject.otherIncidence
dc.subject.otherRetrospective Studies
dc.subject.otherSouth Africa
dc.subject.otherAnti-Retroviral Agents
dc.titleHIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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