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Cross-Sectional and Cumulative Longitudinal Central Nervous System Penetration Effectiveness Scores Are Not Associated With Neurocognitive Impairment in a Well Treated Aging Human Immunodeficiency Virus-Positive Population in Switzerland

Galia M A Santos, Isabella Locatelli, Mélanie Métral, Alexandra Calmy, Thanh Doco Lecompte, Isaure Nadin, Christoph Hauser, Alexia Cusini, Barbara Hasse, Helen Kovari, Philip Tarr, Marcel Stoeckle, Christoph Fux, Caroline Di Benedetto, Patrick Schmid, Katharine E A Darling, Renaud Du Pasquier, Matthias Cavassini & Neurocognitive Assessment In The Metabolic And Aging Cohort (NAMACO) Study Group

abstract

Background
Neurocognitive impairment (NCI) in people with human immunodeficiency virus (PWH) remains a concern despite potent antiretroviral therapy (ART). Higher central nervous system (CNS) penetration effectiveness (CPE) scores have been associated with better CNS human immunodeficiency virus (HIV) replication control, but the association between CPE and NCI remains controversial.

Methods
The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is a subgroup of the Swiss HIV Cohort Study (SHCS) that invited patients aged ≥45 years enrolled in the SHCS and followed-up at NAMACO-affiliated centers in Switzerland to participate between May 2013 and November 2016. In total, 981 patients were enrolled, all of whom underwent standardized neurocognitive assessment. Neurocognitive impairment, if present, was characterized using Frascati criteria. The CPE scores of NAMACO study participants with undetectable plasma HIV-ribonucleic acid at enrollment (909 patients) were analyzed. Cross-sectional CPE scores (at neurocognitive assessment) were examined as potential predictors of NCI in multivariate logistic regression models. The analysis was then repeated taking CPE as a cumulative score (summarizing CPE scores from ART initiation to the time of neurocognitive assessment).

Results
Most patients were male (80%) and Caucasian (92%). Neurocognitive impairment was present in 40%: 27% with HIV-associated NCI (mostly asymptomatic neurocognitive impairment), and 13% with NCI related to other factors. None of the CPE scores, neither cross-sectional nor cumulative, was statistically significantly associated with NCI.

Conclusions
In this large cohort of aviremic PWH, we observed no association between NCI, whether HIV-associated or related to other factors, and CPE score, whether cross-sectional or cumulative.
   
citation Santos G M A, Locatelli I, Métral M, Calmy A, Lecompte T D, Nadin I, Hauser C, Cusini A, Hasse B, Kovari H, Tarr P, Stoeckle M, Fux C, Di Benedetto C, Schmid P, Darling K E A, Du Pasquier R, Cavassini M, Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) Study Group . Cross-Sectional and Cumulative Longitudinal Central Nervous System Penetration Effectiveness Scores Are Not Associated With Neurocognitive Impairment in a Well Treated Aging Human Immunodeficiency Virus-Positive Population in Switzerland. Open Forum Infect Dis 2019; 6:ofz277.
   
type journal paper/review (English)
date of publishing 08-07-2019
journal title Open Forum Infect Dis (6/7)
ISSN print 2328-8957
pages ofz277
PubMed 31304188
DOI 10.1093/ofid/ofz277