Journal of NeuroVirology

, Volume 18, Issue 6, pp 479–487

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

  • Torsak Bunupuradah
  • Ploenchan Chetchotisakd
  • Supunnee Jirajariyavej
  • Victor Valcour
  • Chureeratana Bowonwattanuwong
  • Warangkana Munsakul
  • Virat Klinbuayaem
  • Wisit Prasithsirikul
  • Jiratchaya Sophonphan
  • Apicha Mahanontharit
  • Bernard Hirschel
  • Sorakij Bhakeecheep
  • Kiat Ruxrungtham
  • Jintanat Ananworanich
  • On behalf of the HIV STAR Study Group
Article

Abstract

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.

Keywords

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

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Copyright information

© Journal of NeuroVirology, Inc. 2012

Authors and Affiliations

  • Torsak Bunupuradah
    • 1
  • Ploenchan Chetchotisakd
    • 2
  • Supunnee Jirajariyavej
    • 3
  • Victor Valcour
    • 4
  • Chureeratana Bowonwattanuwong
    • 5
  • Warangkana Munsakul
    • 6
  • Virat Klinbuayaem
    • 7
  • Wisit Prasithsirikul
    • 8
  • Jiratchaya Sophonphan
    • 1
  • Apicha Mahanontharit
    • 1
  • Bernard Hirschel
    • 9
  • Sorakij Bhakeecheep
    • 10
  • Kiat Ruxrungtham
    • 1
    • 11
  • Jintanat Ananworanich
    • 1
    • 11
    • 12
  • On behalf of the HIV STAR Study Group
  1. 1.HIV-NAT, the Thai Red Cross AIDS Research CentreBangkokThailand
  2. 2.Khon Kaen UniversityKhon KaenThailand
  3. 3.Taksin HospitalBangkokThailand
  4. 4.Memory and Aging CenterUniversity of CalifoniaSan FranciscoUSA
  5. 5.Chonburi HospitalChonburiThailand
  6. 6.Faculty of MedicineUniversity of Bangkok Metropolitan AdministrationBangkokThailand
  7. 7.Sanpatong HospitalChiang MaiThailand
  8. 8.Bamrasnaradura InstituteNonthaburiThailand
  9. 9.Geneva UniversityGenevaSwitzerland
  10. 10.The National Health Security OfficeBangkokThailand
  11. 11.Faculty of MedicineChulalongkorn UniversityBangkokThailand
  12. 12.SEARCH, the Thai Red Cross AIDS Research CentreBangkokThailand

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