Journal of NeuroVirology

, Volume 18, Issue 6, pp 479-487

First online:

Neurocognitive impairment in patients randomized to second-line lopinavir/ritonavir-based antiretroviral therapy vs. lopinavir/ritonavir monotherapy

  • Torsak BunupuradahAffiliated withHIV-NAT, the Thai Red Cross AIDS Research Centre Email author 
  • , Ploenchan ChetchotisakdAffiliated withKhon Kaen University
  • , Supunnee JirajariyavejAffiliated withTaksin Hospital
  • , Victor ValcourAffiliated withMemory and Aging Center, University of Califonia
  • , Chureeratana BowonwattanuwongAffiliated withChonburi Hospital
  • , Warangkana MunsakulAffiliated withFaculty of Medicine, University of Bangkok Metropolitan Administration
  • , Virat KlinbuayaemAffiliated withSanpatong Hospital
  • , Wisit PrasithsirikulAffiliated withBamrasnaradura Institute
  • , Jiratchaya SophonphanAffiliated withHIV-NAT, the Thai Red Cross AIDS Research Centre
    • , Apicha MahanontharitAffiliated withHIV-NAT, the Thai Red Cross AIDS Research Centre
    • , Bernard HirschelAffiliated withGeneva University
    • , Sorakij BhakeecheepAffiliated withThe National Health Security Office
    • , Kiat RuxrungthamAffiliated withHIV-NAT, the Thai Red Cross AIDS Research CentreFaculty of Medicine, Chulalongkorn University
    • , Jintanat AnanworanichAffiliated withHIV-NAT, the Thai Red Cross AIDS Research CentreFaculty of Medicine, Chulalongkorn UniversitySEARCH, the Thai Red Cross AIDS Research Centre
    • , On behalf of the HIV STAR Study Group

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We compared rates of neurocognitive impairment (NCI) among 93 Thai adults failing non-nucleoside reverse transcriptase inhibitor (NNRTI)-based combination antiretroviral therapy (cART) before and after switching to lopinavir/ritonavir monotherapy (mLPV/r) vs. tenofovir/lamivudine/LPV/r (TDF/3TC/LPV/r). Participants completed the Color Trails 1 and 2, Digit Symbol, and Grooved Pegboard at weeks 0, 24, and 48. We calculated z-scores using normative data from 451 healthy HIV-negative Thais. We defined NCI as performance of <-1 SD on ≥2 tests. The Thai depression inventory was used to capture depressive symptoms. Lumbar puncture was optional at week 0 and 48. At baseline, median (IQR) age was 36.9 (32.8–40.5) years, and 46 % had primary school education or lower. The median CD4 count was 196 (107–292) cells/mm3, and plasma HIV RNA was 4.1 (3.6–4.5) log10 copies/ml. Almost all (97 %) had circulating recombinant CRF01_AE. At baseline, 20 (47 %) of the mLPV/r vs. 22 (44 %) of TDF/3TC/LPV/r arms met NCI criteria (p = 0.89). The frequency of NCI at week 48 was 30 vs. 32 % (p = 0.85) with 6 vs. 7 % (p = 0.85) developing NCI in the mLPV/r vs. TDF/3TC/LPV/r arms, respectively. Having NCI at baseline and lower education each predicted NCI at week 48. Depression scores at week 48 did not differ between arms (p = 0.47). Cerebrospinal fluid HIV RNA of <50 copies/ml at 48 weeks was observed in five out of seven in mLPV/r vs. three out of four in TDF/3TC/LPV/r arm. The rates of NCI and depression did not differ among cases failing NNRTI-based cART who received mLPV/r compared to LPV/r triple therapy.


Lopinavir/ritonavir monotherapy Neurocognitive impairment Central nervous system penetration effectiveness score Depression