Changes in Cognition During Antiretroviral Therapy: Comparison of 2 Different Ranking Systems to Measure Antiretroviral Drug Efficacy on HIV-Associated Neurocognitive Disorders

Tozzi, Valerio; Balestra, Pietro; Salvatori, Maria Flora; Vlassi, Chrysoula; Liuzzi, Giuseppina; Giancola, Maria Letizia; Giulianelli, Marinella; Narciso, Pasquale; Antinori, Andrea

doi:10.1097/qai.0b013e3181af83d6

Cited by 124 publications

(88 citation statements)

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“…Tozzi et al [18] and Letendre et al [21] both found an association between higher CPE regimens and improved neuropsychological function. This finding was expected, given the improved CSF VL control.…”

Section: Follow-up Assessments N=121mentioning

confidence: 97%

“…Letendre et al [21] also noted that neuropsychological improvement was greater in ART-naïve participants, possibly because participants on ART accumulated resistant mutations. Some of the above studies have been done using ART-naïve participants, [18,19] and others naïve and experienced participants. [20][21][22] Not all studies measured both CSF VL response and cognitive outcomes.…”

Section: Follow-up Assessments N=121mentioning

confidence: 99%

“…[20][21][22] Not all studies measured both CSF VL response and cognitive outcomes. Tozzi et al [18] noted that the correlation between higher CPE score and neuropsychological improvement was exclusive to those who achieved CSF VL suppression. This suggests that VL suppression rather than ART regimen was the key factor.…”

Section: Follow-up Assessments N=121mentioning

confidence: 99%

“…[15] However, studies looking at the correlation between cognitive outcomes and higher CPE regimens have shown mixed results. [18][19][20][21][22] Tozzi et al [18] and Letendre et al [21] both found an association between higher CPE regimens and improved neuropsychological function, while Rourke et al [19] and Ciccarelli et al [20] found no association between CPE scores and cognitive outcomes. Marra et al [22] found an association between higher CPE scores and poorer cognitive performance, which they suggested may relate to increased drug toxicity given the increased CNS penetration.…”

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confidence: 99%

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

2013

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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.

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Section: Follow-up Assessments N=121mentioning

confidence: 97%

Section: Follow-up Assessments N=121mentioning

confidence: 99%

Section: Follow-up Assessments N=121mentioning

confidence: 99%

mentioning

confidence: 99%

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

2013

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“…Letendre et al have reported that the CPE score was correlated with CSF viral load [23] and an updated guideline of CPE scoring was recently published [24]. Other studies have reported a correlation of high CPE score with better neurocognitive performance [25,26] while one study demonstrated worsened neurocognitive performance in HIV-infected individuals receiving ARV regimens with high CPE scores [27]. In addition, the intensification of CNS penetration by changing ARV regimens did not further decrease CSF viral load [28].…”

Section: Pornpun Vivithanapornmentioning

confidence: 99%

Impact of current antiretroviral therapies on neuroAIDS

Vivithanaporn¹,

Gill

Power

2011

Expert Review of Anti-infective Therapy

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Antiviral Agents

Santos,

Reyna Quito

2023

ClinMicroNow

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There are five classes of antiviral agents for the treatment of human immunodeficiency virus type 1 (HIV‐1): nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs), nonucleoside reverse transcriptase inhibitors, protease inhibitors (PIs), entry/fusion inhibitors, and integrase strand transfer inhibitors. PIs are commonly used in combined antiretroviral therapy regimens in combination with NRTI and/or NtRTIs for maximum antiretroviral activity and to minimize the development of resistance. Integrase Strand Transfer Inhibitors a class of antiretroviral drugs, target the HIV‐1 integrase enzyme that mediates transfer of the reverse‐transcribed HIV‐1 DNA into the host chromosome. The common target for antiviral drugs active against both viruses is the reverse transcriptase function of the HIV and hepatitis B virus (HBV) replication enzymes. Chronic HBV infection plays an important role in the morbidity and mortality of HIV‐infected patients. Most of the antiviral compounds that are approved to treat the eight human herpesviruses are nucleoside or nucleotide analogues, which inhibit DNA replication.

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Changes in Cognition During Antiretroviral Therapy: Comparison of 2 Different Ranking Systems to Measure Antiretroviral Drug Efficacy on HIV-Associated Neurocognitive Disorders

Abstract: The CPE score represents a step forward toward the identification of a clinically useful approach to estimating HAART ability to improve cognition.

Cited by 124 publications

References 19 publications

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

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

Impact of current antiretroviral therapies on neuroAIDS

Antiviral Agents

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