Antiretroviral therapy CNS penetration and HIV-1-associated CNS disease.

By:

Garvey, L

Contributor(s): Publication details: 2011ISSN:

00283878

Uniform titles:

Neurology

Online resources:

Click here to access online

Summary: <div style="line-height: 17.999801635742188px;"><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">OBJECTIVE:</h4>The impact of different antiretroviral agents on the risk of developing or surviving CNS disease remains unknown. The aim of this study was to investigate whether using antiretroviral regimens with higher CNS penetration effectiveness (CPE) scores was associated with reduced incidence of CNS disease and improved survival in the UK Collaborative HIV Cohort (CHIC) Study.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">METHODS:</h4>Adults without previous CNS disease, who commenced combination antiretroviral therapy (cART) between 1996 and 2008, were included (n = 22,356). Initial and most recent cART CPE scores were calculated. CNS diseases were HIV encephalopathy (HIVe), progressive multifocal leukoencephalopathy (PML), cerebral toxoplasmosis (TOXO), and cryptococcal meningitis (CRYPTO). Incidence rates and overall survival were stratified by CPE score. A multivariable Poisson regression model was used to identify independent associations.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">RESULTS:</h4>The median (interquartile range) CPE score for initial cART regimen increased from 7 (5-8) in 1996-1997 to 9 (8-10) in 2000-2001 and subsequently declined to 6 (7-8) in 2006-2008. Differences in gender, HIV acquisition risk group, and ethnicity existed between CPE score strata. A total of 251 subjects were diagnosed with a CNS disease (HIVe 80; TOXO 59; CRYPTO 56; PML 54). CNS diseases occurred more frequently in subjects prescribed regimens with CPE scores ≤ 4, and less frequently in those with scores ≥ 10; however, these differences were nonsignificant. Initial and most recent cART CPE scores ≤ 4 were independently associated with increased risk of death.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">CONCLUSION:</h4>Clinical status at time of commencing cART influences antiretroviral selection and CPE score. This information should be considered when utilizing CPE scores for retrospective analyses.</div>

Holdings
Item type	Home library	Collection	Class number	Status	Date due	Barcode
UNKNOWN	Ferriman information and Library Service (North Middlesex) Online	Staff publications for NMDX		Available

NMUH Staff Publications

<div style="line-height: 17.999801635742188px;"><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">OBJECTIVE:</h4>The impact of different&nbsp;antiretroviral&nbsp;agents on the risk of developing or surviving&nbsp;CNS disease&nbsp;remains unknown. The aim of this study was to investigate whether using&nbsp;antiretroviral&nbsp;regimens with higher&nbsp;CNS&nbsp;penetration&nbsp;effectiveness (CPE) scores was associated with reduced incidence of&nbsp;CNS disease&nbsp;and improved survival in the UK Collaborative HIV Cohort (CHIC) Study.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">METHODS:</h4>Adults without previous&nbsp;CNS disease, who commenced combination&nbsp;antiretroviral&nbsp;therapy&nbsp;(cART) between 1996 and 2008, were included (n = 22,356). Initial and most recent cART CPE scores were calculated.&nbsp;CNS&nbsp;diseases&nbsp;were HIV encephalopathy (HIVe), progressive multifocal leukoencephalopathy (PML), cerebral toxoplasmosis (TOXO), and cryptococcal meningitis (CRYPTO). Incidence rates and overall survival were stratified by CPE score. A multivariable Poisson regression model was used to identify independent associations.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">RESULTS:</h4>The median (interquartile range) CPE score for initial cART regimen increased from 7 (5-8) in 1996-1997 to 9 (8-10) in 2000-2001 and subsequently declined to 6 (7-8) in 2006-2008. Differences in gender, HIV acquisition risk group, and ethnicity existed between CPE score strata. A total of 251 subjects were diagnosed with a&nbsp;CNS disease&nbsp;(HIVe 80; TOXO 59; CRYPTO 56; PML 54).&nbsp;CNS&nbsp;diseases&nbsp;occurred more frequently in subjects prescribed regimens with CPE scores ≤ 4, and less frequently in those with scores ≥ 10; however, these differences were nonsignificant. Initial and most recent cART CPE scores ≤ 4 were independently associated with increased risk of death.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">CONCLUSION:</h4>Clinical status at time of commencing cART influences&nbsp;antiretroviral&nbsp;selection and CPE score. This information should be considered when utilizing CPE scores for retrospective analyses.</div>

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