title: Dynamics of cognitive change in HIV-infected individuals commencing three different initial antiretroviral regimens: a randomized, controlled study.
abstract: BACKGROUND
  Improvements in neurocognitive (NC) function have been associated with commencing antiretroviral therapy in HIV-infected subjects. However, the dynamics of such improvements are poorly understood.
  
  
  METHODS
  We assessed changes in NC function via a validated computerized battery (CogState™, Melbourne, Victoria, Australia) at baseline and after 24 and 48 weeks in a subset of therapy-naïve neuro-asymptomatic HIV-infected subjects, randomized to commence three different antiretroviral regimens.
  
  
  RESULTS
  Of 28 subjects enrolled in the study, nine, eight and 11 were randomly allocated to commence tenofovir/emtricitabine with efavirenz (arm 1), atazanavir/ritonavir (arm 2) and zidovudine/abacavir (arm 3), respectively. Overall improvements in NC function were observed at week 24 and function continued to improve at week 48 (changes in z-score for overall cognitive global score of 0.16 and 0.18 at weeks 24 and 48, respectively). Within the NC speed domains, generally greater improvements were observed in arms 2 and 3, compared with arm 1 (changes in z-score for composite speed scores at weeks 24/48 of 0.16/0.16, -0.29/-0.24 and -0.15/-0.31 in arms 1, 2 and 3, respectively; P = 0.04 for change at week 48 in arm 3 versus arm 1). Finally, improvements in executive function occurred later (only observed at week 48) and were driven by improvements in arm 3 (z-score changes of 0.23, 0.06 and -0.78 in arms 1, 2 and 3, respectively; P = 0.02 for change in arm 3 versus arm 1).
  
  
  CONCLUSIONS
  Improvements in NC function continue over the first year after initiating antiretroviral therapy in neuro-asymptomatic HIV-infected subjects.
authors.affiliation: St Mary’s Hospital, Imperial College London, UK. a.winston@imperial.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Winston
authors.forename: R
authors.initials: R
authors.lastname: Puls
authors.forename: S J
authors.initials: SJ
authors.lastname: Kerr
authors.forename: C
authors.initials: C
authors.lastname: Duncombe
authors.forename: P C K
authors.initials: PC
authors.lastname: Li
authors.forename: J M
authors.initials: JM
authors.lastname: Gill
authors.forename: S D
authors.initials: SD
authors.lastname: Taylor-Robinson
authors.forename: S
authors.initials: S
authors.lastname: Emery
authors.forename: D A
authors.initials: DA
authors.lastname: Cooper
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D000069446:Atazanavir Sulfate; D048588:Benzoxazines / Q000008:administration & dosage; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000209:etiology*; D003521:Cyclopropanes; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D015224:Dideoxynucleosides / Q000008:administration & dosage; D004359:Drug Therapy, Combination / Q000379:methods; D000068679:Emtricitabine; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D009842:Oligopeptides / Q000008:administration & dosage; D063065:Organophosphonates / Q000008:administration & dosage; D011725:Pyridines / Q000008:administration & dosage; D019438:Ritonavir / Q000008:administration & dosage; D000068698:Tenofovir; D015215:Zidovudine / Q000008:administration & dosage; D000099227:Abacavir
chemical_list: D000225:Adenine; D000480:Alkynes; D019380:Anti-HIV Agents; D000069446:Atazanavir Sulfate; D048588:Benzoxazines; D003521:Cyclopropanes; D003841:Deoxycytidine; D015224:Dideoxynucleosides; D000068679:Emtricitabine; D009842:Oligopeptides; D063065:Organophosphonates; D011725:Pyridines; D019438:Ritonavir; D000068698:Tenofovir; D015215:Zidovudine; D000099227:Abacavir; C098320:efavirenz