Suchergebnisse

Purpose of the studyThe prevalence of neurocognitive impairment (NCI) in people living with HIV has previously been reported between 20–50%, with prevalence rates of depression reported between 12–71%. The primary objective of the CRANIum study was to describe the prevalence of a positive screen for NCI and depression/anxiety in an HIV‐1‐infected adult population, comparing ARV‐naïve and ‐experienced patients. Here we present an ethnicity analysis of the CRANIum data.MethodsThe study was an epidemiologic, cross‐sectional study that included HIV‐1‐infected patients >18 years old attending a routine clinic visit. One‐third of patients were ART‐naïve, one‐third on a PI/r‐ and one‐third on a NNRTI‐based regimen. The Brief Neurocognitive Screen (BNCS) was used to screen for NCI. It consists of the Digit Symbol and Trailmaking A and B tests. A standard deviation of >1 on 2 tests or >2 on 1 test was considered a positive screen for NCI. The Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety (HADS‐A) and depression (HADS‐D). HADS is self‐administered and consists of 14 items (7 HADS‐A, 7 HADS‐D) scored between 0 to 3. A score of ≥8 was considered as a positive screen for either condition.Summary of results2859 evaluable patients were included from 15 countries. Baseline characteristics are shown in table 1 (*p < 0.05 as compared with Caucasian group). Overall, 41.4% of patients had a positive screen for NCI, 33.3% for anxiety and 15.7% for depression. Results by ethnicity are shown in figure 1.













All subjects
Caucasian
Black
Hispanic
Oriental/Asian
Other




Number of subjects (%)
2859
2254 (78.8)
387 (13.5)
127 (4.4)
50 (1.7)
41 (1.4)


Age ‐ mean, years
42.95
43.80
39.79*
38.56*
40.57*
42.96


Gender ‐%


   ‐ Male
61.7
67.3
26.9*
70.1
64.0
56.1


   ‐ Female
38.3
32.7
73.1*
29.9
36.0
43.9


   Unemployed ‐%
33.1
32.8
35.7
26.0
30.0
51.2*


   > Secondary school education ‐%
82.2
81.3
84.2
89.0*
90.0
78.0


HIV risk factor ‐%


   ‐ Homosexual
42.5
48.5
4.1*
58.3*
36.0
31.7


   ‐ Heterosexual
44.8
37.3
89.4*
39.4*
46.0
51.2


   ‐ Other/ Not known
12.8
14.2
6.5*
2.4*
18.0
17.1


   Duration of HIV infection – mean, months
98.10
103.22
73.46*
79.80*
82.16
113.84


Last recorded HIV‐1 RNA level


   ‐ ART‐naïve‐ median, c/mL
22,390
23,539
11,483
32,241
23,112
12,660


   ‐ ART‐experienced – median, c/mL
39.0
39.0
40.0
28.0
40.0
39.5


   Last recorded CD4 count – mean, c/µL
586.02
598.70
527.57*
550.17
542.40
599.43


   Previous AIDS diagnosis ‐%
17.5
17.7
16.6
17.3
16.0
19.5


   Previous CNS infection ‐%
4.5
3.6
7.2*
6.3
6.0
17.1*


   CD4 count nadir (mean, cells/µL)
295.02
302.65
255.01*
311.97
259.10
247.63


   Hepatitis C co‐infection ‐%
12.4
14.7
1.6*
3.9*
16.0
12.2


   Previous psychiatric diagnosis ‐%
20.2
22.2
9.8*
15.9
20.0
17.1





imageConclusionsIn this large epidemiologic study, the overall prevalence of a positive screen for NCI was high. In particular, the rate in black patients was nearly double that of the overall study population. This finding needs to be interpreted in light of differences in demographics and disease characteristics between ethnic groups. The overall prevalence of a positive screen for depression in HIV‐infected patients was nearly double what has previously been reported in the non‐HIV‐infected population in Europe when utilizing a similar screening tool, with no significant differences between identified ethnic groups. These results support a strategy of regular screening for, and clinical management of NCI, depression, and anxiety in all HIV‐infected patients, with specific focus on NCI in the black population.

Purpose of the studyTo investigate if boosted protease inhibitor monotherapy is associated with a higher risk of neurocognitive impairment (NCI).MethodsHIV‐infected patients from two hospitals in Madrid (Spain) without concomitant major neurocognitive confounders, currently receiving for ≥1 year lopinavir/ritonavir (LPV) or darunavir/ritonavir (DRV) as monotherapy or with two N(t)RTIs were included if they had prolonged (≥1 year) plasma viral suppression (<50 c/mL, single blip allowed). Patients underwent full neurocognitive assessment (7 domains) by two psychologists blinded to the treatment group. NCI was defined as per 2007 Frascati criteria using demographically adjusted normative scores. Rates of NCI and the association between NCI and boosted protease inhibitor monotherapy, adjusted by significant confounders, were analyzed. Two categories of monotherapy duration were considered: short‐term (1–2 years) and long‐term (2–9 years). We evaluated as potential confounding variables: demographics, HIV risk factor, AIDS, CD4 (nadir/current), smoking, alcohol/illicit drug use, prior medical, neurological and psychiatric disease, HCV coinfection, years of ART, prior blips, time with HIV viral suppression, type of protease inhibitor, lipids and HOMA index.Summary of results191 patients (89.5% Caucasian) were included (Table 1).










Triple therapy (n=95)
Monotherapy (n=96)
p value




Male. n (%)
70 (73.7)
70 (72.9)
0.91


Former IVDU. n (%)
30 (31.6)
34 (35.4)
0.85


MSM. n (%)
29 (30.5)
30 (31.3)
0.85


Age. Median (IQR)
44.7 (40.6–48.4)
47.4 (44.8–51.4)
<0.01


Years of education. Mean (SD)
11.3 (4.1)
10.4 (4.4)
0.13


Prior neurologic disease. N (%)
12 (12.6)
10 (10.4)
0.63


Prior psychiatric disease. n (%)
19 (20.0)
24 (25.0)
0.44


Current or past use of illicit drugs. n (%)
49 (53.6)
46 (47.9)
0.66


HCV coinfection (past or active)
43 (47.3)
43 (45.3)
0.54


Years of ART. Median (IQR)
10.7 (4.8–15.7)
14.1 (10.7–15.9)
0.01


Years of monotherapy. Median (IQR)
Not applicable
2.3 (1.7–3.2)
Not applicable


Years suppressed (<50 c/mL). Median (IQR)
4.8 (2.9–8.9)
7.5 (4.5–10.0)
<0.01


No prior blip
63 (66.3)
61 (63.5)
0.17


Currently on LPV. n (%)
70 (73.7)
53 (55.2)
<0.01


Currently on DRV. n (%)
25 (26.3)
43 (44.8)
<0.01


CPE score (2010). Median (IQR)
7 (7–7)
3 (3–3)
Not applicable


CD4 cell nadir. Median (IQR)
153 (49–255)
182 (76–288)
0.11


CD4 cell current. Median (IQR)
560 (440–754)
629.5 (476–845.5)
<0.05




Proportion (95% CI) with NCI: Overall: 27.2% (20.9–33.6, all asymptomatic or mild). Triple therapy: 31.6 (22.1–41.0). 1–2 years of monotherapy (n=40): 25.0 (11.3–38.7). 2–9 years of monotherapy (n=56): 21.4 (10.5–32.3) No differences in rates of NCI were found by treatment group (p=0.38). In our regression model confounding variables for NCI were years on ART, ethnicity, years of education, transmission category and the HOMA index. Adjusted by those variables the odds ratio (95% CI) for NCI of patients receiving boosted protease inhibitor monotherapy monotherapy during 1–2 years was 0.85 (0.29–2.50) and for 2–9 years was 0.40 (0.14–1.15).ConclusionsBoosted protease inhibitor monotherapy, regardless of duration, was not associated with a higher rate of neurocognitive impairment than triple drug ART. These results call into question the ability of neuropenetrance scores to predict the neuroefficacy of antiretroviral regimens in HIV‐infected patients with adequate blood viral suppression.