6th IAS Conference On HIV Pathogenesis, Treatment and Prevention


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MOAB0104 - Oral Abstract Session

Examining the impact of CNS penetration effectiveness of combination antiretroviral treatment (cART) on neuropsychological outcomes in persons living with HIV: findings from the Ontario HIV Treatment Network (OHTN) cohort study

Presented by Sean B. Rourke (Canada).

S.B. Rourke1,2,3, A. Carvalhal4, A.R. Zipursky1,2, T. Bekele1, J. McCombe5,6, A. Rachlis3,7, E. Collins8, M.J. Gill6, J. Raboud3,9, A. Burchell1,10

1Ontario HIV Treatment Network, Toronto, Canada, 2St. Michael's Hospital, Psychiatry, Toronto, Canada, 3University of Toronto, Toronto, Canada, 4McMaster University, Psychiatry and Behavioral Neurosciences, Hamilton, Canada, 5University of Alberta, Department of Medicine, Calgary, Canada, 6University of Calgary, Department of Medicine, Calgary, Canada, 7Sunnybrook Health Sciences Centre, Toronto, Canada, 8University of Toronto, Psychiatry, Toronto, Canada, 9University Health Network, Toronto, Canada, 10McGill University, Oncology, Montreal, Canada

Background: The prevalence of mild neurocognitive impairment in HIV continues to increase in the era of cART. These impairments have a significant impact on everyday functioning and quality of life. Letendre (2006, 2010) has shown an association between ARV regimens with higher CNS penetration effectiveness (CPE) and improved CSF viral load response and neurological outcomes.
Methods: Within the OHTN Cohort Study, 545 persons received neuropsychological testing at baseline evaluation and 255 were seen at follow-up. Neuropsychological tests assessed working memory (Spatial Span), complex psychomotor efficiency (Digit Symbol), dexterity (Grooved Pegboard), and verbal learning/memory (Hopkins Verbal Learning Test). ARV agents were assigned a CPE score according to Letendre 2006 and 2010 criteria, and summed to generate regimen CPE scores. Sample: 82% male; mean age 47.5 years; mean education 13.9 years; mean time with HIV 11.9 years; mean viral load log of 1.89; 67.5% had a nadir CD4 count ≤ 200.
Results: Using Letendre criteria, we dichotomized the 2006 CPE scores into low (< 2, 42%) and high (≥2, 58%) effectiveness. We also dichotomized the groups based on 2010 CPE scores into low (< 8, 38%) and high (≥8, 62%) effectiveness. A generalized estimating equation was used to evaluate the relationship between CPE of current ARV regimen and neuropsychological outcomes. The analysis was adjusted for age, education, gender, CD4 nadir, present viral load, time since HIV diagnosis, Hepatitis C diagnosis, depression, and substance abuse. No significant associations were found between CPE score and neurocognitive outcomes using either 2006 or 2010 criteria.
Conclusions: In the first Canadian study to evaluate CPE score and neurocognitive outcomes, there was no association between CNS penetration effectiveness of ARV agents and neuropsychological outcomes. Subsequent analyses are being conducted to examine the cumulative impact of length of ARV history and CPE score on neurocognitive outcomes.

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