A prospective cohort study of neurocognitive function in aviremic HIV-infected patients treated with 1 or 3 antiretrovirals
| Autor: | Alicia González-Baeza, Miriam Estébanez, Juan González-García, María L. Montes-Ramírez, Asunción Hernando, Francisco Xavier Zamora, Federico Pulido, María Lagarde, Jose R. Arribas, Susana Monge, Ignacio Pérez-Valero, Francisco Arnalich, Carmen Bayón, Jose I Bernardino |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty business.industry SIDA Lamivudine Integrase inhibitor Lopinavir Clinical trial chemistry.chemical_compound Infectious Diseases chemistry Rilpivirine Internal medicine Immunology medicine HIV Protease Inhibitor Prospective cohort study business Darunavir medicine.drug |
| Popis: | (See the Editorial Commentary by Letendre on pages 1635–7.) Antiretroviral therapy (ART) is able to protect against severe cases of HIV-associated neurocognitive disorders (HAND)—such as HIV dementia [1]—but apparently cannot completely protect against the milder forms of HAND [2]. Indeed, a number of studies have demonstrated a high prevalence of milder forms of HAND in patients receiving effective ART [3, 4]. It is unknown why ART may be ineffective protection against mild forms of HAND. Several studies have found higher rates of HAND in patients treated with ART regimens characterized by poor central nervous system penetration effectiveness (CPE) ranks [5, 6]. Based on these findings, it has been postulated that patients receiving ART regimens with poor CPE might have a higher risk of HAND [7–9]. The lack of knowledge about the importance of low CPE ranks in patients receiving nucleoside-sparing regimens is worrisome because an increasing number of patients are being exposed to these ART combinations. Clinical trials are evaluating dual combinations of a boosted protease inhibitor and a second drug (an integrase inhibitor [10–12] or lamivudine [13]), monotherapy with a boosted protease inhibitor [14], or a dual combination of an integrase inhibitor and rilpivirine [15]. It is not known whether these unconventional ART regimens can provide enough protection against HAND. Three published studies—2 cross-sectional observations and 1 small clinical trial—have compared the neurocognitive function of patients receiving monotherapy or triple therapy for maintenance of viral suppression [16–18]. The results of the 2 cross-sectional studies were inconclusive because of the limitations inherent to their design [16, 17]. The clinical trial had to be stopped prematurely owing to a high rate of virological failure in patients randomized to receive monotherapy [18]. For these reasons, the question about the importance of the number of antiretroviral drugs for the prevention of HAND remains unanswered. To elucidate whether prolonged exposure to protease inhibitor monotherapy may increase the risk of HAND, we performed what is to our knowledge the first prospective cohort study to compare the neurocognitive evolution between aviremic HIV-infected patients treated with boosted protease inhibitor monotherapy and those receiving triple-drug ART. |
| Databáze: | OpenAIRE |
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