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01-12-2012

Neurocognitive impairment in patients randomized to second-line lopinavir/ritonavir-based antiretroviral therapy vs. lopinavir/ritonavir monotherapy

Authors: Torsak Bunupuradah, Ploenchan Chetchotisakd, Supunnee Jirajariyavej, Victor Valcour, Chureeratana Bowonwattanuwong, Warangkana Munsakul, Virat Klinbuayaem, Wisit Prasithsirikul, Jiratchaya Sophonphan, Apicha Mahanontharit, Bernard Hirschel, Sorakij Bhakeecheep, Kiat Ruxrungtham, Jintanat Ananworanich, On behalf of the HIV STAR Study Group

Published in: Journal of NeuroVirology | Issue 6/2012

Abstract

We compared rates of neurocognitive impairment (NCI) among 93 Thai adults failing non-nucleoside reverse transcriptase inhibitor (NNRTI)-based combination antiretroviral therapy (cART) before and after switching to lopinavir/ritonavir monotherapy (mLPV/r) vs. tenofovir/lamivudine/LPV/r (TDF/3TC/LPV/r). Participants completed the Color Trails 1 and 2, Digit Symbol, and Grooved Pegboard at weeks 0, 24, and 48. We calculated z-scores using normative data from 451 healthy HIV-negative Thais. We defined NCI as performance of <-1 SD on ≥2 tests. The Thai depression inventory was used to capture depressive symptoms. Lumbar puncture was optional at week 0 and 48. At baseline, median (IQR) age was 36.9 (32.8–40.5) years, and 46 % had primary school education or lower. The median CD4 count was 196 (107–292) cells/mm³, and plasma HIV RNA was 4.1 (3.6–4.5) log₁₀ copies/ml. Almost all (97 %) had circulating recombinant CRF01_AE. At baseline, 20 (47 %) of the mLPV/r vs. 22 (44 %) of TDF/3TC/LPV/r arms met NCI criteria (p = 0.89). The frequency of NCI at week 48 was 30 vs. 32 % (p = 0.85) with 6 vs. 7 % (p = 0.85) developing NCI in the mLPV/r vs. TDF/3TC/LPV/r arms, respectively. Having NCI at baseline and lower education each predicted NCI at week 48. Depression scores at week 48 did not differ between arms (p = 0.47). Cerebrospinal fluid HIV RNA of <50 copies/ml at 48 weeks was observed in five out of seven in mLPV/r vs. three out of four in TDF/3TC/LPV/r arm. The rates of NCI and depression did not differ among cases failing NNRTI-based cART who received mLPV/r compared to LPV/r triple therapy.

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Title: Neurocognitive impairment in patients randomized to second-line lopinavir/ritonavir-based antiretroviral therapy vs. lopinavir/ritonavir monotherapy
Authors: Torsak Bunupuradah
Ploenchan Chetchotisakd
Supunnee Jirajariyavej
Victor Valcour
Chureeratana Bowonwattanuwong
Warangkana Munsakul
Virat Klinbuayaem
Wisit Prasithsirikul
Jiratchaya Sophonphan
Apicha Mahanontharit
Bernard Hirschel
Sorakij Bhakeecheep
Kiat Ruxrungtham
Jintanat Ananworanich
On behalf of the HIV STAR Study Group
Publication date: 01-12-2012
Publisher: Springer US
Published in: Journal of NeuroVirology / Issue 6/2012
Print ISSN: 1355-0284
Electronic ISSN: 1538-2443
DOI: https://doi.org/10.1007/s13365-012-0127-9

At a glance: The STEP trials

Springer Medicine

Neurocognitive impairment in patients randomized to second-line lopinavir/ritonavir-based antiretroviral therapy vs. lopinavir/ritonavir monotherapy

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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