Can high central nervous system penetrating antiretroviral regimens protect against the onset of HIV-associated neurocognitive disorders?
OBJECTIVE:To assess changes over time in neuropsychological test results (NPr) and risk factors among a regularly followed HIV-infected patient population. METHODS:Prospective cohort of HIV-infected patients randomly selected to undergo neuropsychological follow-up. Test score was adjusted for age,...
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| Veröffentlicht in: | AIDS (London) 2014-02, Vol.28 (4), p.493-501 |
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| creator | Vassallo, Matteo Durant, Jacques Biscay, Virginie Lebrun-Frenay, Christine Dunais, Brigitte Laffon, Muriel Harvey-Langton, Alexandra Cottalorda, Jacqueline Ticchioni, Michel Carsenti, Helene Pradier, Christian Dellamonica, Pierre |
| description | OBJECTIVE:To assess changes over time in neuropsychological test results (NPr) and risk factors among a regularly followed HIV-infected patient population.
METHODS:Prospective cohort of HIV-infected patients randomly selected to undergo neuropsychological follow-up. Test score was adjusted for age, sex and education. Patients were divided into five groupsnormal tests, neuropsychological deficit (one impaired cognitive domain), asymptomatic neurocognitive disorders (ANIs), mild neurocognitive disorders (MNDs) and HIV-associated dementia (HAD). Demographic and background parameters including CSF drug concentration penetration effectiveness (CPE) score 2010 were recorded. Changes in NPr and associated risk factors were analyzed.
RESULTS:Two hundred and fifty-six patients underwent neuropsychological tests and 96 accepted follow-up approximately 2 years later. The groups were comparable. Upon neuropsychological retesting, six patients improved, 31 worsened and 59 were stable. The proportion of patients with HIV-associated neurocognitive disorders (HANDs) rose from 26 to 45%, with ANIs and MNDs still mostly represented. Most patients initially diagnosed with HANDs remained stable, five of 25 showed clinical improvement and three of 25 deteriorated. Of 33 patients with normal tests, four deteriorated, whereas 24 of 38 with initial neuropsychological deficit had poorer NPr, and contributed most of the new HAND cases. Patients with clinical deterioration had a lower CPE score both at inclusion (6.9 vs. 8.1; P = 0.005) and at the end of follow-up (7.2 vs. 7.8; P = 0.08) than those with improved or stable performance. This was confirmed by multivariate analysis.
CONCLUSION:Patients with higher CPE scores upon inclusion and at the end of follow-up were at lower risk of clinical worsening, suggesting that combination antiretroviral therapy with better CSF penetration could protect against cognitive deterioration. |
| doi_str_mv | 10.1097/QAD.0000000000000096 |
| format | Article |
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METHODS:Prospective cohort of HIV-infected patients randomly selected to undergo neuropsychological follow-up. Test score was adjusted for age, sex and education. Patients were divided into five groupsnormal tests, neuropsychological deficit (one impaired cognitive domain), asymptomatic neurocognitive disorders (ANIs), mild neurocognitive disorders (MNDs) and HIV-associated dementia (HAD). Demographic and background parameters including CSF drug concentration penetration effectiveness (CPE) score 2010 were recorded. Changes in NPr and associated risk factors were analyzed.
RESULTS:Two hundred and fifty-six patients underwent neuropsychological tests and 96 accepted follow-up approximately 2 years later. The groups were comparable. Upon neuropsychological retesting, six patients improved, 31 worsened and 59 were stable. The proportion of patients with HIV-associated neurocognitive disorders (HANDs) rose from 26 to 45%, with ANIs and MNDs still mostly represented. Most patients initially diagnosed with HANDs remained stable, five of 25 showed clinical improvement and three of 25 deteriorated. Of 33 patients with normal tests, four deteriorated, whereas 24 of 38 with initial neuropsychological deficit had poorer NPr, and contributed most of the new HAND cases. Patients with clinical deterioration had a lower CPE score both at inclusion (6.9 vs. 8.1; P = 0.005) and at the end of follow-up (7.2 vs. 7.8; P = 0.08) than those with improved or stable performance. This was confirmed by multivariate analysis.
CONCLUSION:Patients with higher CPE scores upon inclusion and at the end of follow-up were at lower risk of clinical worsening, suggesting that combination antiretroviral therapy with better CSF penetration could protect against cognitive deterioration.</description><identifier>ISSN: 0269-9370</identifier><identifier>EISSN: 1473-5571</identifier><identifier>DOI: 10.1097/QAD.0000000000000096</identifier><identifier>PMID: 24472743</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Adult ; Aged ; AIDS Dementia Complex - epidemiology ; AIDS Dementia Complex - prevention & control ; AIDS/HIV ; Anti-Retroviral Agents - administration & dosage ; Anti-Retroviral Agents - pharmacokinetics ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiviral agents ; Biological and medical sciences ; Cohort Studies ; Female ; HIV Infections - complications ; HIV Infections - drug therapy ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Immunodeficiencies ; Immunodeficiencies. Immunoglobulinopathies ; Immunopathology ; Infectious diseases ; Lentivirus ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Prospective Studies ; Retroviridae ; Risk Factors ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Young Adult</subject><ispartof>AIDS (London), 2014-02, Vol.28 (4), p.493-501</ispartof><rights>2014 Lippincott Williams & Wilkins, Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4656-285ca9a9c4e56d96e22d28a9440b911b07c71eab3cbdb8efc2e4878c142a6f7c3</citedby><cites>FETCH-LOGICAL-c4656-285ca9a9c4e56d96e22d28a9440b911b07c71eab3cbdb8efc2e4878c142a6f7c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28402563$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24472743$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vassallo, Matteo</creatorcontrib><creatorcontrib>Durant, Jacques</creatorcontrib><creatorcontrib>Biscay, Virginie</creatorcontrib><creatorcontrib>Lebrun-Frenay, Christine</creatorcontrib><creatorcontrib>Dunais, Brigitte</creatorcontrib><creatorcontrib>Laffon, Muriel</creatorcontrib><creatorcontrib>Harvey-Langton, Alexandra</creatorcontrib><creatorcontrib>Cottalorda, Jacqueline</creatorcontrib><creatorcontrib>Ticchioni, Michel</creatorcontrib><creatorcontrib>Carsenti, Helene</creatorcontrib><creatorcontrib>Pradier, Christian</creatorcontrib><creatorcontrib>Dellamonica, Pierre</creatorcontrib><title>Can high central nervous system penetrating antiretroviral regimens protect against the onset of HIV-associated neurocognitive disorders?</title><title>AIDS (London)</title><addtitle>AIDS</addtitle><description>OBJECTIVE:To assess changes over time in neuropsychological test results (NPr) and risk factors among a regularly followed HIV-infected patient population.
METHODS:Prospective cohort of HIV-infected patients randomly selected to undergo neuropsychological follow-up. Test score was adjusted for age, sex and education. Patients were divided into five groupsnormal tests, neuropsychological deficit (one impaired cognitive domain), asymptomatic neurocognitive disorders (ANIs), mild neurocognitive disorders (MNDs) and HIV-associated dementia (HAD). Demographic and background parameters including CSF drug concentration penetration effectiveness (CPE) score 2010 were recorded. Changes in NPr and associated risk factors were analyzed.
RESULTS:Two hundred and fifty-six patients underwent neuropsychological tests and 96 accepted follow-up approximately 2 years later. The groups were comparable. Upon neuropsychological retesting, six patients improved, 31 worsened and 59 were stable. The proportion of patients with HIV-associated neurocognitive disorders (HANDs) rose from 26 to 45%, with ANIs and MNDs still mostly represented. Most patients initially diagnosed with HANDs remained stable, five of 25 showed clinical improvement and three of 25 deteriorated. Of 33 patients with normal tests, four deteriorated, whereas 24 of 38 with initial neuropsychological deficit had poorer NPr, and contributed most of the new HAND cases. Patients with clinical deterioration had a lower CPE score both at inclusion (6.9 vs. 8.1; P = 0.005) and at the end of follow-up (7.2 vs. 7.8; P = 0.08) than those with improved or stable performance. This was confirmed by multivariate analysis.
CONCLUSION:Patients with higher CPE scores upon inclusion and at the end of follow-up were at lower risk of clinical worsening, suggesting that combination antiretroviral therapy with better CSF penetration could protect against cognitive deterioration.</description><subject>Adult</subject><subject>Aged</subject><subject>AIDS Dementia Complex - epidemiology</subject><subject>AIDS Dementia Complex - prevention & control</subject><subject>AIDS/HIV</subject><subject>Anti-Retroviral Agents - administration & dosage</subject><subject>Anti-Retroviral Agents - pharmacokinetics</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiviral agents</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunodeficiencies</subject><subject>Immunodeficiencies. Immunoglobulinopathies</subject><subject>Immunopathology</subject><subject>Infectious diseases</subject><subject>Lentivirus</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Prospective Studies</subject><subject>Retroviridae</subject><subject>Risk Factors</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><subject>Young Adult</subject><issn>0269-9370</issn><issn>1473-5571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1u1DAUhS0EokPhDRDyBolNiu04_lmhagq0UiWEBGwjx7lJDIk92M5UfQTeGpcZQLAAbyxffefec30QekrJGSVavnx_fnFG_jha3EMbymVdNY2k99GGMKErXUtygh6l9LkgDVHqITphnEsmeb1B37bG48mNE7bgczQz9hD3YU043aYMC96Bh1LPzo_Y-OxieYW9uyMjjG4Bn_Auhgw2YzMa51PGeQIcfIKMw4Avrz5VJqVgncnQl_ZrDDaM3mW3B9y7FGIPMb16jB4MZk7w5Hifoo9vXn_YXlbX795ebc-vK8tFIyqmGmu00ZZDI3otgLGeKaM5J52mtCPSSgqmq23XdwoGy4ArqSzlzIhB2voUvTj0La6_rpByu7hkYZ6Nh7J3S6VotBS1qP-Pcs0kZZo2BeUH1MaQUoSh3UW3mHjbUtLe5dWWvNq_8yqyZ8cJa7dA_0v0M6ACPD8CJlkzD9F469JvTnHCmh9W1YG7CXMu3_llXm8gthOYOU__9vAdcLSxkw</recordid><startdate>20140220</startdate><enddate>20140220</enddate><creator>Vassallo, Matteo</creator><creator>Durant, Jacques</creator><creator>Biscay, Virginie</creator><creator>Lebrun-Frenay, Christine</creator><creator>Dunais, Brigitte</creator><creator>Laffon, Muriel</creator><creator>Harvey-Langton, Alexandra</creator><creator>Cottalorda, Jacqueline</creator><creator>Ticchioni, Michel</creator><creator>Carsenti, Helene</creator><creator>Pradier, Christian</creator><creator>Dellamonica, Pierre</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7T2</scope><scope>7T5</scope><scope>7U2</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope></search><sort><creationdate>20140220</creationdate><title>Can high central nervous system penetrating antiretroviral regimens protect against the onset of HIV-associated neurocognitive disorders?</title><author>Vassallo, Matteo ; Durant, Jacques ; Biscay, Virginie ; Lebrun-Frenay, Christine ; Dunais, Brigitte ; Laffon, Muriel ; Harvey-Langton, Alexandra ; Cottalorda, Jacqueline ; Ticchioni, Michel ; Carsenti, Helene ; Pradier, Christian ; Dellamonica, Pierre</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4656-285ca9a9c4e56d96e22d28a9440b911b07c71eab3cbdb8efc2e4878c142a6f7c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>AIDS Dementia Complex - epidemiology</topic><topic>AIDS Dementia Complex - prevention & control</topic><topic>AIDS/HIV</topic><topic>Anti-Retroviral Agents - administration & dosage</topic><topic>Anti-Retroviral Agents - pharmacokinetics</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antiviral agents</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>Human immunodeficiency virus</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Immunodeficiencies</topic><topic>Immunodeficiencies. Immunoglobulinopathies</topic><topic>Immunopathology</topic><topic>Infectious diseases</topic><topic>Lentivirus</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Prospective Studies</topic><topic>Retroviridae</topic><topic>Risk Factors</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vassallo, Matteo</creatorcontrib><creatorcontrib>Durant, Jacques</creatorcontrib><creatorcontrib>Biscay, Virginie</creatorcontrib><creatorcontrib>Lebrun-Frenay, Christine</creatorcontrib><creatorcontrib>Dunais, Brigitte</creatorcontrib><creatorcontrib>Laffon, Muriel</creatorcontrib><creatorcontrib>Harvey-Langton, Alexandra</creatorcontrib><creatorcontrib>Cottalorda, Jacqueline</creatorcontrib><creatorcontrib>Ticchioni, Michel</creatorcontrib><creatorcontrib>Carsenti, Helene</creatorcontrib><creatorcontrib>Pradier, Christian</creatorcontrib><creatorcontrib>Dellamonica, Pierre</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Safety Science and Risk</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>AIDS (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vassallo, Matteo</au><au>Durant, Jacques</au><au>Biscay, Virginie</au><au>Lebrun-Frenay, Christine</au><au>Dunais, Brigitte</au><au>Laffon, Muriel</au><au>Harvey-Langton, Alexandra</au><au>Cottalorda, Jacqueline</au><au>Ticchioni, Michel</au><au>Carsenti, Helene</au><au>Pradier, Christian</au><au>Dellamonica, Pierre</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can high central nervous system penetrating antiretroviral regimens protect against the onset of HIV-associated neurocognitive disorders?</atitle><jtitle>AIDS (London)</jtitle><addtitle>AIDS</addtitle><date>2014-02-20</date><risdate>2014</risdate><volume>28</volume><issue>4</issue><spage>493</spage><epage>501</epage><pages>493-501</pages><issn>0269-9370</issn><eissn>1473-5571</eissn><abstract>OBJECTIVE:To assess changes over time in neuropsychological test results (NPr) and risk factors among a regularly followed HIV-infected patient population.
METHODS:Prospective cohort of HIV-infected patients randomly selected to undergo neuropsychological follow-up. Test score was adjusted for age, sex and education. Patients were divided into five groupsnormal tests, neuropsychological deficit (one impaired cognitive domain), asymptomatic neurocognitive disorders (ANIs), mild neurocognitive disorders (MNDs) and HIV-associated dementia (HAD). Demographic and background parameters including CSF drug concentration penetration effectiveness (CPE) score 2010 were recorded. Changes in NPr and associated risk factors were analyzed.
RESULTS:Two hundred and fifty-six patients underwent neuropsychological tests and 96 accepted follow-up approximately 2 years later. The groups were comparable. Upon neuropsychological retesting, six patients improved, 31 worsened and 59 were stable. The proportion of patients with HIV-associated neurocognitive disorders (HANDs) rose from 26 to 45%, with ANIs and MNDs still mostly represented. Most patients initially diagnosed with HANDs remained stable, five of 25 showed clinical improvement and three of 25 deteriorated. Of 33 patients with normal tests, four deteriorated, whereas 24 of 38 with initial neuropsychological deficit had poorer NPr, and contributed most of the new HAND cases. Patients with clinical deterioration had a lower CPE score both at inclusion (6.9 vs. 8.1; P = 0.005) and at the end of follow-up (7.2 vs. 7.8; P = 0.08) than those with improved or stable performance. This was confirmed by multivariate analysis.
CONCLUSION:Patients with higher CPE scores upon inclusion and at the end of follow-up were at lower risk of clinical worsening, suggesting that combination antiretroviral therapy with better CSF penetration could protect against cognitive deterioration.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>24472743</pmid><doi>10.1097/QAD.0000000000000096</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | AIDS (London), 2014-02, Vol.28 (4), p.493-501 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Adult Aged AIDS Dementia Complex - epidemiology AIDS Dementia Complex - prevention & control AIDS/HIV Anti-Retroviral Agents - administration & dosage Anti-Retroviral Agents - pharmacokinetics Antibiotics. Antiinfectious agents. Antiparasitic agents Antiviral agents Biological and medical sciences Cohort Studies Female HIV Infections - complications HIV Infections - drug therapy Human immunodeficiency virus Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infectious diseases Lentivirus Male Medical sciences Middle Aged Pharmacology. Drug treatments Prospective Studies Retroviridae Risk Factors Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Young Adult |
| title | Can high central nervous system penetrating antiretroviral regimens protect against the onset of HIV-associated neurocognitive disorders? |
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