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ART monotherapy does not affect neurocognitive performance
Among patients with HIV who have viral suppression, the number of antiretroviral drugs in a regimen does not appear to affect neurocognitive performance, according to researchers from the HIV Unit at Hospital Universitario La Paz in Madrid.
“Protease inhibitor monotherapy for maintenance of plasma HIV suppression does not appear to be associated with worse neurocognitive evolution or higher incidence of neurocognitive impairment than triple-drug ART therapy after 1 year of prospective follow-up,” the researchers wrote in Clinical Infectious Diseases. “Our findings suggest that in patients who have durable virological plasma suppression and good immunological status, the number of antiretrovirals included in the regimen do not influence neurocognitive function evolution.”
The prospective study included 134 patients with suppressed viral load for at least 1 year. Half received monotherapy with either lopinavir/ritonavir (Kaletra, Abbott) or darunavir (Prezista, Janssen) boosted with ritonavir (Norvir, AbbVie). The other half received triple therapy with a protease inhibitor and either tenofovir/emtricitabine (Truvada, Gilead) or abacavir/lamivudine (Epzicom, ViiV). The patients had been recruited from a parent cross-sectional study in which they underwent a comprehensive neurocognitive evaluation. One year after enrollment into the current longitudinal study, the patients underwent a second evaluation.
After 1 year, 129 patients remained virally suppressed. The researchers found that 1 year of monotherapy did not significantly affect Global Deficit Score, after adjusting for age, total years of ART, geographical region, hepatitis C coinfection and HOMA index. These results were similar in the intention-to-treat analysis and the on-treatment analysis. There were no differences in neurocognitive performance, neurocognitive decline or neurocognitive impairment evolution, measured by Global Deficit Score or clinical ratings, between patients receiving triple therapy or monotherapy.
“Our results are important because they indicate that the risk of neurocognitive impairment in patients with prolonged viral suppression, treated with unconventional regimens, do not appear to be substantially increased,” the researchers wrote. “Although protease inhibitor monotherapy is not recommended in all guidelines, it is possible that other nuc-sparing combinations such as a boosted protease inhibitor and lamivudine or raltegravir are going to be more frequently used given its good results in antiretroviral naïve or experienced patients.”
Disclosure: The researchers report relationships with Abbott Pharmaceuticals, AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, Janssen, Merck, Roche, Sanofi Aventis, Tibotec, Tobira and ViiV.