Efavirenz associated with cognitive disorders in otherwise asymptomatic HIV-infected patients

Abstract

A high prevalence of HAND was observed in apparently asymptomatic HIV+ individuals. HAND was associated with efavirenz use, suggesting the potential neurotoxicity of this drug. Routine neuropsychological examinations could help clinicians make correct diagnoses and manage mild, but clinically relevant, forms of HAND.

Pharmacokinetics and Pharmacodynamics of Antiretrovirals in the Central Nervous System

“…Furthermore being on efavirenz was independently associated with the diagnosis of HAND in a cohort of stable HIV-positive patients. [200] One recent study reported that cognition improved for up to 96 weeks in a group of immunologically and virologically stable patients who elected to come off treatment; the improvement was significant in all participants but greater in efavirenz recipients. [133] These results raise the possibility that ARVs concentrations to some extent may have some detrimental effects: this may be particularly relevant for individuals with specific genetic profiles but it must be compared to the clear beneficial effect of HAART on compartmentalized viral control.…”

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

“…This finding was expected, given the improved CSF VL control. However, Rourke et al [19] and Ciccarelli et al [20] found no association between CPE scores and cognitive outcomes. In this regard it is important to remember that CSF VL is not necessarily equivalent to brain VL.…”

“…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. Tozzi et al [18] noted that the correlation between higher CPE score and neuropsychological improvement was exclusive to those who achieved CSF VL suppression.…”

“…[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.…”

High prevalence of HIV-associated neurocognitive disorder in HIV-infected patients with a baseline CD4 count ≤ 350 cells/μL in Shanghai, China

“…These symptoms may result in patients having a poorer cognitive performance. This hypothesis is supported by a recent study reporting that efavirenz is associated with cognitive disorders in otherwise asymptomatic HIV-infected patients (20). Other previously reported risk factors for HAND include a decreased CD4 count, anemia, declining platelet count, high HIV-RNA viral load in the CNS, and hepatitis C coinfection (20)(21)(22).…”