The Effect of Central Nervous System Penetration Effectiveness of Highly Active Antiretroviral Therapy on Neuropsychological Performance and Neuroimaging in HIV Infected Individuals

J Neuroimmune Pharmacol. 2015 Sep;10(3):487-92. doi: 10.1007/s11481-015-9610-4. Epub 2015 Apr 22.

Abstract

The incidence of HIV-associated dementia has been greatly reduced in the era of highly active antiretroviral therapy (HAART); however milder forms of cognitive impairment persist. It remains uncertain whether HAART regimens with a high degree of central nervous system penetration effectiveness (CPE) exert beneficial neurological outcomes in HIV-infected (HIV+) individuals on stable treatment. Sixty-four HIV-infected adults on HAART were assigned a CPE score using a published ranking system and divided into high (≥7; n = 35) and low (<7; n = 29) CPE groups. All participants completed neuropsychological testing in addition to structural neuroimaging. Neuropsychological tests included measures known to be sensitive to HIV with values converted into standardized scores (NPZ-4) based on published normative scores. A semi-automated methodology was utilized to assess brain volumetrics within cortical (grey and white matter) and subcortical (thalamus, caudate, putamen) regions of interest. Analyses assessed NPZ-4 and brain volumetric differences between HIV+ individuals with high and low CPE scores. No significant differences in brain integrity were observed between the two groups. Long-term HAART regimens with a high degree of CPE were not associated with significantly improved neuropsychological or neuroimaging outcomes in HIV+ adults. Results suggest that alternate mechanisms may potentially contribute to better neurological outcomes in the era of HAART.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Retroviral Agents / pharmacokinetics*
  • Antiretroviral Therapy, Highly Active*
  • Brain* / drug effects
  • Brain* / pathology
  • Brain* / physiopathology
  • Central Nervous System / drug effects*
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / etiology
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Neuroimaging
  • Neuropsychological Tests

Substances

  • Anti-Retroviral Agents