title: The Effect of Central Nervous System Penetration Effectiveness of Highly Active Antiretroviral Therapy on Neuropsychological Performance and Neuroimaging in HIV Infected Individuals.
abstract: The incidence of HIV-associated dementia has been greatly reduced in the era of highly active antiretroviral therapy (HAART); however milder forms of cognitive impairment persist. It remains uncertain whether HAART regimens with a high degree of central nervous system penetration effectiveness (CPE) exert beneficial neurological outcomes in HIV-infected (HIV+) individuals on stable treatment. Sixty-four HIV-infected adults on HAART were assigned a CPE score using a published ranking system and divided into high (≥7; n = 35) and low (<7; n = 29) CPE groups. All participants completed neuropsychological testing in addition to structural neuroimaging. Neuropsychological tests included measures known to be sensitive to HIV with values converted into standardized scores (NPZ-4) based on published normative scores. A semi-automated methodology was utilized to assess brain volumetrics within cortical (grey and white matter) and subcortical (thalamus, caudate, putamen) regions of interest. Analyses assessed NPZ-4 and brain volumetric differences between HIV+ individuals with high and low CPE scores. No significant differences in brain integrity were observed between the two groups. Long-term HAART regimens with a high degree of CPE were not associated with significantly improved neuropsychological or neuroimaging outcomes in HIV+ adults. Results suggest that alternate mechanisms may potentially contribute to better neurological outcomes in the era of HAART.
authors.affiliation: Department of Psychology, University of Missouri- Saint Louis, Saint Louis, MO, USA.
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Baker
authors.forename: Robert H
authors.initials: RH
authors.lastname: Paul
authors.forename: Jodi M
authors.initials: JM
authors.lastname: Heaps-Woodruff
authors.forename: Jee Yoon
authors.initials: JY
authors.lastname: Chang
authors.forename: Mario
authors.initials: M
authors.lastname: Ortega
authors.forename: Zachary
authors.initials: Z
authors.lastname: Margolin
authors.forename: Christina
authors.initials: C
authors.lastname: Usher
authors.forename: Brian
authors.initials: B
authors.lastname: Basco
authors.forename: Sarah
authors.initials: S
authors.lastname: Cooley
authors.forename: Beau M
authors.initials: BM
authors.lastname: Ances
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000493:pharmacokinetics*; D023241:Antiretroviral Therapy, Highly Active; D001921:Brain / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D002490:Central Nervous System / Q000187:drug effects*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D009483:Neuropsychological Tests
chemical_list: D044966:Anti-Retroviral Agents