title: Validation of the CNS Penetration-Effectiveness rank for quantifying antiretroviral penetration into the central nervous system.
abstract: OBJECTIVE
  To evaluate whether penetration of a combination regimen into the central nervous system (CNS), as estimated by the CNS Penetration-Effectiveness (CPE) rank, is associated with lower cerebrospinal fluid (CSF) viral load.
  
  
  METHODS
  Data were analyzed from 467 participants who were human immunodeficiency virus (HIV) seropositive and who reported antiretroviral (ARV) drug use. Individual ARV drugs were assigned a penetration rank of 0 (low), 0.5 (intermediate), or 1 (high) based on their chemical properties, concentrations in CSF, and/or effectiveness in the CNS in clinical studies. The CPE rank was calculated by summing the individual penetration ranks for each ARV in the regimen.
  
  
  RESULTS
  The median CPE rank was 1.5 (interquartile range, 1-2). Lower CPE ranks correlated with higher CSF viral loads. Ranks less than 2 were associated with an 88% increase in the odds of detectable CSF viral load. In multivariate regression, lower CPE ranks were associated with detectable CSF viral loads even after adjusting for total number of ARV drugs, ARV drug adherence, plasma viral load, duration and type of the current regimen, and CD4 count.
  
  
  CONCLUSIONS
  Poorer penetration of ARV drugs into the CNS appears to allow continued HIV replication in the CNS as indicated by higher CSF HIV viral loads. Because inhibition of HIV replication in the CNS is probably critical in treating patients who have HIV-associated neurocognitive disorders, ARV treatment strategies that account for CNS penetration should be considered in consensus treatment guidelines and validated in clinical studies.
authors.affiliation: University of California, San Diego, 150 W Washington St, San Diego, CA 92103, USA. sletendre@ucsd.edu
authors.forename: Scott
authors.initials: S
authors.lastname: Letendre
authors.forename: Jennifer
authors.initials: J
authors.lastname: Marquie-Beck
authors.forename: Edmund
authors.initials: E
authors.lastname: Capparelli
authors.forename: Brookie
authors.initials: B
authors.lastname: Best
authors.forename: David
authors.initials: D
authors.lastname: Clifford
authors.forename: Ann C
authors.initials: AC
authors.lastname: Collier
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Gelman
authors.forename: Justin C
authors.initials: JC
authors.lastname: McArthur
authors.forename: J Allen
authors.initials: JA
authors.lastname: McCutchan
authors.forename: Susan
authors.initials: S
authors.lastname: Morgello
authors.forename: David
authors.initials: D
authors.lastname: Simpson
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ellis
mesh_terms: D000328:Adult; D000465:Algorithms; D019380:Anti-HIV Agents / Q000097:blood / Q000134:cerebrospinal fluid / Q000493:pharmacokinetics*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002490:Central Nervous System / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000378:metabolism*; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D015203:Reproducibility of Results; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D004338:Drug Combinations