Objective Determine if antiretroviral (ARV) regimens with good central nervous system (CNS) penetration control HIV in cerebrospinal fluid (CSF) and improve cognition. Design Multi-site longitudinal observational study. Setting Research clinics. Subjects 101 individuals with advanced HIV beginning or changing a new potent ARV regimen. Data for 79 subjects were analyzed. Participants underwent structured history and neurological examination, venipuncture, lumbar puncture, neuropsychological tests at entry, 24 and 52 weeks. Intervention ARV regimens were categorized as CNS penetration effectiveness (CPE) rank ≥ 2 or < 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, neuropsychological test scores. Results Odds of suppression of CSF HIV RNA were higher when CPE rank ≥ 2 compared to < 2. Odds of suppression of plasma HIV RNA were not associated with CPE rank. Among subjects with impaired neuropsychological performance at entry, those prescribed regimens with a CPE rank ≥ 2 or more ARVs had lower NPZ4 over the course of the study. Conclusions ARV 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, ARVs with good CNS penetration were associated with poorer neurocognitive performance. A larger, controlled trial is required before any conclusions regarding the influence of specific ARVs on neurocognitive performance should be made.

Cognitive behavioral intervention programs can effectively reduce the potential of HIV transmission to others among PLH who report significant transmission risk behavior.

A comparison of 1-stage versus 2-stage fusion in treating rigid thoracic curves in AIS did not show significant differences in safety or efficacy but did demonstrate significant difference in length of stay and patient cost.