Dual antiretroviral therapies are effective and safe regimens in the central nervous system of neurologically symptomatic people living with HIV
Autor: | Giulia Guastamacchia, Marco Nigra, Cristiana Atzori, D. Vai, Andrea Calcagno, Simone Domini, Walter Rugge, Mattia Trunfio, Enrica Borgogno, Stefano Bonora, Lorenzo Mighetto, Giovanni Di Perri |
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Rok vydání: | 2020 |
Předmět: |
0301 basic medicine
Central Nervous System Male medicine.medical_specialty Immunology Central nervous system Neurocognitive Disorders Inflammation HIV Infections Article 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid Central Nervous System Diseases Internal medicine medicine Immunology and Allergy Humans 030212 general & internal medicine Depression (differential diagnoses) Cerebrospinal Fluid Retrospective Studies medicine.diagnostic_test business.industry Lumbar puncture Middle Aged Viral Load CD4 Lymphocyte Count 030104 developmental biology Infectious Diseases medicine.anatomical_structure Cross-Sectional Studies HIV-1 Biomarker (medicine) Anxiety RNA Viral Female medicine.symptom business Neurocognitive |
Zdroj: | AIDS |
ISSN: | 1473-5571 |
Popis: | OBJECTIVE Aim of this study was to compare cerebrospinal fluid (CSF) virological control, biomarkers and neurocognition of neurologically symptomatic patients on dual antiretroviral therapies (dual therapy) vs. 2 nucleoside reverse transcriptase inhibitors-based three-drug regimens (triple therapy). DESIGN Retrospective monocentric cross-sectional study. METHODS We analysed data from people living with HIV undergoing lumbar puncture for clinical/research reasons with plasma HIV-RNA less than 200 copies/ml and neurological/neurocognitive symptoms without significant contributing comorbidities. We measured CSF HIV-RNA, inflammation, blood-brain barrier integrity, neuronal damage and astrocytosis biomarkers (five biomarkers by ELISA and five indices by immunoturbidimetry) and recorded the neurocognitive performance (14 tests). CSF escape was defined as any case of CSF HIV-RNA 0.5 Log10 higher than viraemia or any case of detectable CSF HIV-RNA coupled with undetectable viraemia. RESULTS A total of 78 patients on triple therapy and 19 on dual therapy were included. Overall, 75.3% male, median age 51 years (46-58), current CD4 count 545 cells/μl (349-735), time on current regimens 18 months (8-29), but length of plasma suppression 32 months (14-94). The two groups did not differ in terms of HIV-associated neurological diagnoses, demographic and viro-immunological features. Undetectable CSF HIV-RNA (73.7% in dual therapy vs. 78.2% in triple therapy, p.67) and CSF escape (21.1% in dual therapy vs. 19.2% in triple therapy, p.86) did not differ. No difference was observed in depression, anxiety, neurocognition (in 63 participants) nor in any tested biomarker. CONCLUSION In people living with HIV with neurological/neurocognitive symptoms, peripherally effective dual therapy can show CSF virosuppression, inflammation, neuronal and astrocyte integrity and neurocognition comparable to triple therapy. |
Databáze: | OpenAIRE |
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