HIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes

Helen M Cross, Marc I Combrinck, John A Joska


Background. The human immunodeficiency virus (HIV) can give rise to a spectrum of neuropsychological impairments known collectively as HIV-associated neurocognitive disorders (HAND). Although antiretroviral therapy (ART) has reduced the incidence of HIV dementia, the prevalence of milder forms of HAND has increased. It has been postulated that incomplete central nervous system (CNS) viral suppression or potential drug toxicity, both of which could be related to the CNS penetration effectiveness (CPE) of ART regimens, may contribute to this phenomenon.

Objective. This study compared cognitive outcomes in clade C-infected HIV patients in South Africa treated for 1 year with ART regimens with differing CPE scores.

Methods. We assessed 111 HIV-positive patients with varying levels of cognitive function at baseline (pre-ART) and then a year later. A neuropsychological battery was administered at both visits to derive global deficit scores. ART regimen data were collected at the follow-up visit. Some participants remained ART-naïve during this period, thus providing a non-treatment control group.

Results. Significantly more ART recipients maintained or improved cognitive function compared with patients not on ART (p=0.017). There was no significant difference in cognitive outcomes between higher and lower CPE regimen groups (p=0.473).

Conclusions. ART preserves or improves cognition in HIV-infected patients after 1 year, irrespective of the regimen’s CPE. South Africa’s current low CPE-scored first-line regimen performed as well as higher CPE-scored regimens. These findings are reassuring for South Africa, but larger, longer-term studies would be more definitive. 

Authors' affiliations

Helen M Cross, Division of Neurology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

Marc I Combrinck, Divisions of Neurology and Geriatric Medicine, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town

John A Joska, Division of Neuropsychiatry, Department of Psychiatry, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

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HIV Dementia; ART; CPE

Cite this article

South African Medical Journal 2013;103(10):758-762. DOI:10.7196/SAMJ.6677

Article History

Date submitted: 2013-01-08
Date published: 2013-09-18

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