title: A prospective cohort study of neurocognitive function in aviremic HIV-infected patients treated with 1 or 3 antiretrovirals.
abstract: BACKGROUND
  The evolution of neurocognitive performance in aviremic human immunodeficiency virus (HIV)-positive patients treated with <3 antiretrovirals is unknown.
  
  
  METHODS
  We prospectively included aviremic (≥1 year) HIV-positive patients, without concomitant major neurocognitive confounders, currently receiving boosted lopinavir or darunavir as monotherapy (n = 67) or triple antiretroviral therapy (ART) (n = 67) for ≥1 year. We evaluated neurocognitive function (7 domains) at baseline and after 1 year. We performed analysis of covariance to evaluate if 1 additional year of exposure to monotherapy compared with triple ART had an effect on Global Deficit Score (GDS) changes after adjustment for potential confounders. We also compared the evolution of neurocognitive performance and impairment rates.
  
  
  RESULTS
  Intention-to-treat analysis showed that monotherapy did not influence 1-year GDS change after adjustment for significant confounders (age, ethnicity, duration of therapy, hepatitis C virus status, and HOMA-IR index); the adjusted effect was -0.04 (95% confidence interval, -.14 to .05; P = .38). Neurocognitive stability was observed with monotherapy and triple therapy (GDS crude mean change, -0.09 [95% confidence interval, -.16 to -.01] vs -0.08 [-.14 to -.02]), after 1 year of follow-up, similar proportions of patients changed neurocognitive status from impaired to unimpaired (monotherapy, 4 of 18 [22.2%]; triple therapy, 4 of 19 [21.1%]; P = .91) and vice versa (monotherapy, 5 of 44 [10.2%] and triple therapy, 3 of 45 [6.3%]; P = .48). Similar results were observed in an on-treatment analysis and with use of clinical ratings instead of GDS changes.
  
  
  CONCLUSIONS
  The number of antiretrovirals included in the ART regimen does not seem to influence the evolution of neurocognitive function in HIV-infected patients with suppressed plasma viremia.
authors.affiliation: HIV Unit-Internal Medicine Service.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Pérez-Valero
authors.affiliation: HIV Unit-Internal Medicine Service.
authors.forename: Alicia
authors.initials: A
authors.lastname: González-Baeza
authors.affiliation: HIV Unit-Internal Medicine Service.
authors.forename: Miriam
authors.initials: M
authors.lastname: Estébanez
authors.affiliation: Centro Nacional de Epidemiología, Instituto de Salud Carlos III.
authors.forename: Susana
authors.initials: S
authors.lastname: Monge
authors.affiliation: HIV Unit-Internal Medicine Service.
authors.forename: María L
authors.initials: ML
authors.lastname: Montes-Ramírez
authors.affiliation: Psychiatry Service, Hospital Universitario La Paz-IdiPAZ.
authors.forename: Carmen
authors.initials: C
authors.lastname: Bayón
authors.affiliation: HIV Unit-Internal Medicine Service, Hospital Universitario 12 de Octubre, i+12, Madrid.
authors.forename: Federico
authors.initials: F
authors.lastname: Pulido
authors.affiliation: HIV Unit-Internal Medicine Service.
authors.forename: José I
authors.initials: JI
authors.lastname: Bernardino
authors.affiliation: HIV Unit-Internal Medicine Service.
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Zamora
authors.affiliation: HIV Unit-Internal Medicine Service.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: González-García
authors.affiliation: HIV Unit-Internal Medicine Service, Hospital Universitario 12 de Octubre, i+12, Madrid.
authors.forename: María
authors.initials: M
authors.lastname: Lagarde
authors.affiliation: Departamento de Especialidades Médicas, Universidad Europea de Madrid, Villaviciosa de Odón, Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Hernando
authors.affiliation: HIV Unit-Internal Medicine Service.
authors.forename: Francisco
authors.initials: F
authors.lastname: Arnalich
authors.affiliation: HIV Unit-Internal Medicine Service.
authors.forename: José R
authors.initials: JR
authors.lastname: Arribas
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003072:Cognition Disorders / Q000821:virology*; D000069454:Darunavir; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D006801:Humans; D008137:Longitudinal Studies; D061466:Lopinavir / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013449:Sulfonamides / Q000008:administration & dosage
chemical_list: D017320:HIV Protease Inhibitors; D013449:Sulfonamides; D061466:Lopinavir; D000069454:Darunavir
keywords: HIV-1; darunavir; lopinavir; neurocognitive evolution; protease inhibitor monotherapy
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