title: Neurocognitive impairment in patients randomized to second-line lopinavir/ritonavir-based antiretroviral therapy vs. lopinavir/ritonavir monotherapy.
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/mm(3), and plasma HIV RNA was 4.1 (3.6-4.5) log(10) 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.
authors.affiliation: HIV-NAT, the Thai Red Cross AIDS Research Centre, Bangkok, Thailand. torsak.b@hivnat.org
authors.forename: Torsak
authors.initials: T
authors.lastname: Bunupuradah
authors.forename: Ploenchan
authors.initials: P
authors.lastname: Chetchotisakd
authors.forename: Supunnee
authors.initials: S
authors.lastname: Jirajariyavej
authors.forename: Victor
authors.initials: V
authors.lastname: Valcour
authors.forename: Chureeratana
authors.initials: C
authors.lastname: Bowonwattanuwong
authors.forename: Warangkana
authors.initials: W
authors.lastname: Munsakul
authors.forename: Virat
authors.initials: V
authors.lastname: Klinbuayaem
authors.forename: Wisit
authors.initials: W
authors.lastname: Prasithsirikul
authors.forename: Jiratchaya
authors.initials: J
authors.lastname: Sophonphan
authors.forename: Apicha
authors.initials: A
authors.lastname: Mahanontharit
authors.forename: Bernard
authors.initials: B
authors.lastname: Hirschel
authors.forename: Sorakij
authors.initials: S
authors.lastname: Bhakeecheep
authors.forename: Kiat
authors.initials: K
authors.lastname: Ruxrungtham
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D018791:CD4 Lymphocyte Count; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology* / Q000821:virology; D003863:Depression / Q000209:etiology / Q000523:psychology* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D019259:Lamivudine / Q000494:pharmacology / Q000627:therapeutic use; D061466:Lopinavir / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D063065:Organophosphonates / Q000494:pharmacology / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D019438:Ritonavir / Q000494:pharmacology / Q000627:therapeutic use; D000068698:Tenofovir; D019562:Viral Load / Q000187:drug effects
chemical_list: D017320:HIV Protease Inhibitors; D063065:Organophosphonates; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D061466:Lopinavir; D019259:Lamivudine; D000068698:Tenofovir; D000225:Adenine; D019438:Ritonavir