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AIDS. 2019 Apr 16. doi: 10.1097/QAD.0000000000002236. [Epub ahead of print]

Altered neuropsychological performance and reduced brain volumetrics in people living with HIV on integrase strand transfer inhibitors.

Author information

1
Division of Infectious Diseases in the Department of Medicine, Washington University in St Louis, St Louis, USA.
2
Department of Neurology, Washington University in St Louis, St Louis, USA.
3
Missouri Institute of Mental Health, University of Missouri St Louis, St Louis, USA.
4
Hope Center, Washington University in St Louis, St Louis, USA.

Abstract

OBJECTIVES:

Neuropsychiatric symptoms have been reported in people living with HIV (PLWH) on integrase strand transfer inhibitors (INSTIs) in post marketing analysis. Limited data exists regarding brain integrity (function and structure) in PLWH prescribed INSTIs compared to other HIV treatment regimens.

DESIGN:

A cross-sectional analysis of PLWH on combined antiretroviral therapy (cART) aged >18 years at a single institution.

METHODS:

Neuropsychological tests were administered to calculate domain deficit scores (DDS) in learning/memory, executive function, and motor/psychomotor domains. Cortical and subcortical volumes from magnetic resonance imaging were obtained using the FreeSurfer software suite (v5.3) (Harvard University, Boston, MA).

RESULTS:

Of 202 participants, median age 55 (48, 60) years old, 49% were on INSTI-based cART. PLWH on INSTIs were similar to individuals on non-INSTIs in terms of age, sex, race, education years, smoking history, depression scores, psychiatric medication use, presence of hepatitis C infection, history of substance use, HIV infection duration and recent or nadir CD4+ T cell count. Participants in the INSTI group performed worse than non-INSTI users in the verbal learning and memory domain (1.25 (interquartile range; 0.25, 2) versus (0.25 (0, 1.8); pā€Š=ā€Š0.02). The INSTI and non-INSTI groups were similar for other cognitive domains. Frontal, brain stem, and cerebellar volumes were reduced in INSTI compared to non-INSTI users (all pā€Š=ā€Š<0.05).

CONCLUSION:

We demonstrated modest differences in learning/memory performance and smaller brain volumes in PLWH on INSTI-based regimens compared to non-INSTI users. Prospective studies are needed to define mechanisms and the clinical significance of reduced brain integrity in PLWH on INSTIs.

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