Antiretroviral penetration into the CNS and incidence of AIDS-defining neurologic conditions

Caniglia, Ellen C.; Cain, Lauren E.; Justice, Amy; Tate, Janet; Logan, Roger; Sabin, Caroline; Winston, Alan; van Sighem, Ard; Miro, Jose M.; Podzamczer, Daniel; Olson, Ashley; Arribas, José Ramón; Moreno, Santiago; Meyer, Laurence; Del Romero, Jorge; Dabis, François; Bucher, Heiner C.; Wandeler, Gilles; Vourli, Georgia; Skoutelis, Athanasios; ... (2014). Antiretroviral penetration into the CNS and incidence of AIDS-defining neurologic conditions. Neurology, 83(2), pp. 134-141. Lippincott Williams & Wilkins 10.1212/WNL.0000000000000564

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OBJECTIVE The link between CNS penetration of antiretrovirals and AIDS-defining neurologic disorders remains largely unknown.METHODS: HIV-infected, antiretroviral therapy-naive individuals in the HIV-CAUSAL Collaboration who started an antiretroviral regimen were classified according to the CNS Penetration Effectiveness (CPE) score of their initial regimen into low (<8), medium (8-9), or high (>9) CPE score. We estimated "intention-to-treat" hazard ratios of 4 neuroAIDS conditions for baseline regimens with high and medium CPE scores compared with regimens with a low score. We used inverse probability weighting to adjust for potential bias due to infrequent follow-up.RESULTS: A total of 61,938 individuals were followed for a median (interquartile range) of 37 (18, 70) months. During follow-up, there were 235 cases of HIV dementia, 169 cases of toxoplasmosis, 128 cases of cryptococcal meningitis, and 141 cases of progressive multifocal leukoencephalopathy. The hazard ratio (95% confidence interval) for initiating a combined antiretroviral therapy regimen with a high vs low CPE score was 1.74 (1.15, 2.65) for HIV dementia, 0.90 (0.50, 1.62) for toxoplasmosis, 1.13 (0.61, 2.11) for cryptococcal meningitis, and 1.32 (0.71, 2.47) for progressive multifocal leukoencephalopathy. The respective hazard ratios (95% confidence intervals) for a medium vs low CPE score were 1.01 (0.73, 1.39), 0.80 (0.56, 1.15), 1.08 (0.73, 1.62), and 1.08 (0.73, 1.58).CONCLUSIONS: We estimated that initiation of a combined antiretroviral therapy regimen with a high CPE score increases the risk of HIV dementia, but not of other neuroAIDS conditions.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Wandeler, Gilles

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

10 Sep 2014 16:11

Last Modified:

07 Jun 2015 02:30

Publisher DOI:

10.1212/WNL.0000000000000564

PubMed ID:

24907236

BORIS DOI:

10.7892/boris.53577

URI:

https://boris.unibe.ch/id/eprint/53577

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