BACKGROUND

The objective of our study was to compare two different central nervous system penetration-effectiveness (CPE) scores for the prediction of cognitive dysfunction in HIV-infected patients.

METHODS

We performed a cross-sectional single cohort study, consecutively enrolled during routine outpatient visits. HIV-infected subjects on antiretroviral therapy with plasma HIV RNA<50 copies/ml were included. A neuropsychological battery was administered. Each patient was classified as cognitively impaired on the basis of results obtained in age-, gender-, education- and nationality-matched healthy HIV-negative subjects. Self-reported adherence to antiviral therapy was measured on a 0-100 visual analogue scale. CPE rank was calculated for each antiretroviral regimen based on rules proposed by the CHARTER group in the 2008 original version (orCPE rank) and the 2010 revised version (revCPE rank). Neuroeffectiveness categories were analysed based on cutoffs of ≥1.5 (orCPE rank) or ≥6 (revCPE rank).

RESULTS

A total of 101 patients were enrolled (66% male, median age 47 years, median education 13 years); mean adherence was 81%. orCPE rank ≥1.5 and revCPE rank ≥6 were observed in 85.0% and 78.2% of patients, respectively (P=0.31). Asymptomatic neurocognitive impairment (ANI) was diagnosed in 50 (49.5%) subjects. In a multivariable model, after adjusting for nationality, adherence and nadir CD4(+) T-cell count, orCPE rank did not show an association with cognitive performance (P=0.704). By contrast, patients with revCPE rank ≥6 (OR 0.32, 95% CI 0.11, 0.95; P=0.039) and adherence ≥80% (OR 0.39, 95% CI 0.15, 0.99; P=0.047) showed a decreased risk of cognitive impairment.

CONCLUSIONS

A high prevalence of ANI was observed in virologically suppressed HIV-infected individuals. The revCPE rank showed improved association with neurocognitive dysfunction over the orCPE rank. Moreover, a relationship between cognitive impairment and adherence to antiretroviral therapy was found.