Department of Psychology, California State University, Northridge, Los Angeles, CA 91330, USA.
Department of Neuropsychology, Pacific Neuroscience Institute Foundation, Santa Monica, CA 90404, USA.
Viruses. 2022 May 26;14(6):1151. doi: 10.3390/v14061151.
This literature review summarizes the existing research examining the CNS penetration effectiveness (CPE) score and neurocognitive outcomes (i.e., neuropsychological assessment and neurocognitive screening) in HIV+ individuals. Despite the effectiveness of Combined Antiretroviral Therapy (CART) in reducing mortality and morbidity in HIV and controlling viral replication, HIV often persists in the Central Nervous System (CNS), and rates of neurocognitive impairment remain higher than predicted in the post-CART era. The CPE score was developed to rank antiretroviral regimens on their ability to penetrate the CNS and potency in inhibiting the virus, and it has been examined in relation to neurocognitive functioning for over a decade. Based on the results of 23 studies, we conclude that CPE is not as strongly associated with neurocognitive outcomes as initially hypothesized, although higher CPE ARV regimens may be associated with modest, improved outcomes in global neurocognitive functioning, and to a lesser extent attention/working memory and learning/memory. Conclusions, however, are limited by the heterogeneity in study design and methods, and the lack of a more recent CPE metric update. It is recommended that future research in this area employ comprehensive, standardized neuropsychological test batteries and examine domain-level performance, and use the newer 2010 CPE metric, although an updated CPE ranking is urgently needed.
这篇文献综述总结了现有的研究,这些研究考察了 HIV+个体中的中枢神经系统穿透效果(CPE)评分和神经认知结果(即神经心理学评估和神经认知筛查)。尽管联合抗逆转录病毒疗法(CART)在降低 HIV 的死亡率和发病率以及控制病毒复制方面非常有效,但 HIV 经常在中枢神经系统(CNS)中持续存在,并且在 CART 后时代,神经认知障碍的发生率仍然高于预期。CPE 评分旨在根据其穿透中枢神经系统的能力和抑制病毒的效力对抗逆转录病毒方案进行排名,并且已经在超过十年的时间里与神经认知功能相关进行了研究。基于 23 项研究的结果,我们得出结论,CPE 与神经认知结果的相关性不如最初假设的那么强,尽管较高的 CPE ARV 方案可能与全球神经认知功能的适度改善相关,而在注意力/工作记忆和学习/记忆方面的相关性较小。然而,结论受到研究设计和方法的异质性以及缺乏更新的 CPE 指标的限制。建议该领域的未来研究采用全面、标准化的神经心理学测试组合,并检查域级表现,并使用更新的 2010 年 CPE 指标,尽管迫切需要更新的 CPE 排名。