HIV-replication control rates needed to prevent neurocognitive performance (NP) decline.

Type: Poster
Title: HIV-replication control rates needed to prevent neurocognitive performance (NP) decline.
Authors: PĂ©rez-Valero I, Heaton R, Franklin D, Letendre S, Deutsch R, Gelman B, Simpson D, Collier A, Grant I, and the CHARTER Group
Year: 2014
Publication: Conference on Retroviruses and Opportunistic Infections.

Background: There are controversies regarding the level of HIV-suppression needed to prevent neurocognitive performance (NP) decline and the capacity of different ART types to prevent NP decline in HIV-suppressed patients.

Methods: Prospective comparison of NP decline rates in non-HIV controls (HIV-) and HIV-infected volunteers (HIV+) with >2 years of follow up presenting 1 of these 3 patterns of HIV virological control: Always suppressed (AS) on ART (HIV RNA <50cop/mL); Sometimes suppressed on ART (SS); And always detectable despite ART (AD). Patients were selected from CHARTER and HNRP cohorts. A comparison between HIV+ AS treated with PI+2NRTIs vs. NNRTI+2NRTIs was also performance. NP decline was defined using regression-based norms for NP change that corrected for all known factors that may influence test-retest differences in normals (Cysique et al. J Clin Exp Neuropsychol 2011; 33:505-22).

Results: 93 HIV- and 346 HIV+ (AS: 103, SS: 112 and AD: 131 patients) were analysed. Overall, HIV+ were more frequently (p=0.004) males (80.6% vs. 66.7%) of older age (mean: 43.8 vs. 36.1 years; p=0.001) than HIV-. Proportions of NP decline were, after a median time of follow up of 2.5 years: HIV- 15%, AS 18.5%, SS 22.3% and AD 26%). Comparing to HIV-, only HIV+ AD presented higher rates of NP decline (p=0.046), after adjusting for significant cofactors: Neurological comorbidities (p=0.031) and history previous ART regimens (p=0.004). In the HIV+ AS group, 37 volunteers received NNRTI+2NRTIs and 43 PI+2NRTIs. Comparing both ART groups, HIV+ AS on PI+2NRTIs had similar baseline characteristics than NNRTI+2NRTIs except for a lower CD4 nadir (median: 93 vs. 180 cells; p=0.041) and a lower CPE score vs. 2.0 (median: 7 vs. 8; p=0.045). NP decline of HIV+ AS on PI+2NRTIs was 7% vs. 24.3% on NNRTI+2NRTIs (p=0.03). This difference was independent of significant cofounders (CD4 nadir and CPE score vs. 2.0). Relative risk for NNRTI+2NRTIs group was 3.49 (1.02-11.93).

Conclusions: Comparing to HIV-, higher rates of NP decline were only detected in HIV+ AD. Higher rates of NP decline were observed in HIV+ AS on NNRTI+2NRTIs than in HIV+ AS on PI+2NRTIs.