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01-10-2020 | Human Immunodeficiency Virus

Lifetime antiretroviral exposure and neurocognitive impairment in HIV

Authors: Precious Amusan, Christopher Power, M. John Gill, Daniela Gomez, Erika Johnson, Leah H. Rubin, Esther Fujiwara

Published in: Journal of NeuroVirology | Issue 5/2020

Abstract

Despite the availability of modern antiretroviral therapy (ART), neurocognitive impairment persists among some persons with HIV (PWH). We investigated the role of exposure to four major classes of ARTs in neurocognitive impairment in PWH. A single-site cohort of 343 PWH was recruited. Lifetime ART medication history was obtained from medical health records. We evaluated the role of ART exposure as a predictor of neurocognitive impairment using univariate analyses and machine learning, while accounting for potential effects of demographic, clinical, and comorbidity-related risk factors. Out of a total of 26 tested variables, two random forest analyses identified the most important characteristics of a neurocognitively impaired group (N = 59): Compared with a neurocognitively high-performing group (N = 132; F₁-score = 0.79), we uncovered 13 important risk factors; compared with an intermediate-performing group (N = 152; F₁-score = 0.75), 16 risk factors emerged. Longer lifetime ART exposure, especially to integrase inhibitors, was one of the most important predictors of neurocognitive impairment in both analyses (rank 2 of 13 and rank 4 of 16, respectively), superseding effects of age (rank 11/13, rank 15/16) and HIV duration (rank 13/13, rank 16/16). Concerning specific integrase inhibitors, the impaired group had significantly longer dolutegravir exposure (p = 0.011) compared with the high-performing group (p = 0.012; trend compared with the intermediate group p = 0.063). A longer duration to integrase inhibitor intake was negatively related to cognition in this cohort. Our findings suggest that possible cognitive complications of long-term exposure to integrase inhibitors, in particular dolutegravir, should be closely monitored in PWH.

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Title: Lifetime antiretroviral exposure and neurocognitive impairment in HIV
Authors: Precious Amusan
Christopher Power
M. John Gill
Daniela Gomez
Erika Johnson
Leah H. Rubin
Esther Fujiwara
Publication date: 01-10-2020
Publisher: Springer International Publishing
Keywords: Human Immunodeficiency Virus
Dolutegravir
Published in: Journal of NeuroVirology / Issue 5/2020
Print ISSN: 1355-0284
Electronic ISSN: 1538-2443
DOI: https://doi.org/10.1007/s13365-020-00870-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lifetime antiretroviral exposure and neurocognitive impairment in HIV

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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