Abstract
It is unknown if, compared to a triple drug antiretroviral therapy, boosted protease inhibitor monotherapy leads to worse results in specific neuropsychological processes. In our study, we included patients virologically suppressed (≥1 year), on antiretroviral therapy, without concomitant major neurocognitive confounders, receiving boosted lopinavir or darunavir as monotherapy (n = 96) or as triple therapy with two nucleoside reverse transcriptase inhibitors (n = 95). All patients underwent a comprehensive neuropsychological test battery (14 neuropsychological measures, covering seven domains). Both groups were compared in average score distributions and rates of neuropsychological deficits. Similar comparisons were conducted only for patients with neurocognitive impairment. In the adjusted analysis, we found only small differences between groups in the entire sample: better verbal learning (p = 0.02; d = 0.28) and verbal recall scores (p < 0.01; d = 0.25) in patients on boosted protease inhibitor monotherapy and slightly better motor skills with dominant hand (p = 0.02; d = 0.23) scores in patients on triple therapy. No greater proportion of deficits in the protease inhibitor monotherapy group was found in any neuropsychological measure. In neurocognitively impaired patients, we found similar outcomes in verbal learning, verbal recall, and motor skills with dominant hand but with larger effect sizes. Close similarities in the neurocognitive pattern between groups question the clinical relevance of the number of neuroactive drugs included in the regimen. These results also suggest that peripheral viral load control may be a good indicator of brain protection.
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Acknowledgments
This work was supported by grant PI10/00483, Fondo de Investigaciones Sanitarias, Insituto de Salúd Carlos III. Alicia González-Baeza is supported by a predoctoral fellowship from Insituto de Salúd Carlos III. Dr I. Pérez-Valero, Dr. M. Estébanez and S. Monge are supported by Rio Hortega fellowships financed by Fondo de Investigaciones Sanitarias. Dr. M. Lagarde is supported by a fellowship financed by Instituto de Investigación Hospital 12 de Octubre. IdiPAZ AIDS and infectious diseases investigator group is partially supported by “Red de Investigación en SIDA” (AIDS Research Network) (RIS) RD07/0006/2007.
Conflict of interest
Authors have the following competing interests: Alicia González-Baeza, Fernando Carvajal, Carmen Bayón, Ignacio Pérez-Valero, Miriam Estébanez, Jose I Bernardino, Susana Monge, María Lagarde, Asunción Hernando, Francisco Arnalich, and José R Arribas have no financial relationship with the organization that sponsored the research.
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González-Baeza, A., Carvajal, F., Bayón, C. et al. Pattern of neurocognitive function in patients receiving boosted protease inhibitor monotherapy: a detailed neuropsychological study. J. Neurovirol. 20, 362–370 (2014). https://doi.org/10.1007/s13365-014-0251-9
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DOI: https://doi.org/10.1007/s13365-014-0251-9