Does efavirenz replacement improve neurological function in treated HIV infection?

作者：Payne B; Chadwick T J; Blamire A; Anderson K N; Parikh J; Qian J; Hynes A M; Wilkinson J; Price D A

来源：HIV Medicine, 2017, 18(9): 690-695.

DOI：10.1111/hiv.12503

<jats:sec><jats:title>Objectives</jats:title><jats:p>The contribution of specific antiretroviral drugs to cognitive function in <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐infected people remains poorly understood. Efavirenz (<jats:styled-content style="fixed-case">EFV</jats:styled-content>) may plausibly cause cognitive impairment. The objective of this study was therefore to determine whether chronic <jats:styled-content style="fixed-case">EFV</jats:styled-content> therapy is a modifier of neurocognitive and neurometabolic function in the setting of suppressive highly active antiretroviral therapy.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We performed an open‐label phase <jats:styled-content style="fixed-case">IV</jats:styled-content> controlled trial. Adult subjects who were stable on suppressive <jats:styled-content style="fixed-case">EFV</jats:styled-content> therapy for at least 6 months were switched to ritonavir‐boosted lopinavir (<jats:styled-content style="fixed-case">LPV</jats:styled-content>/r) with no change in the nucleoside reverse transcriptase inhibitor (<jats:styled-content style="fixed-case">NRTI</jats:styled-content>) backbone. The following parameters were assessed before and 10 weeks after therapy switch: cognitive by CogState<jats:sup>®</jats:sup> computerized battery); brain metabolites (by proton magnetic resonance spectroscopy); brain activity [by attentional processing task‐based functional magnetic resonance imaging]; and sleep quantity and quality [by sleep diary, Pittsburgh Sleep Quality Index (<jats:styled-content style="fixed-case">PSQI</jats:styled-content>) and Epworth Sleepiness Scale].</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Sixteen subjects completed the study. Despite most subjects (81%) self‐reporting memory problems at baseline, cognitive function, brain metabolites, and brain activity showed no change at 10 weeks after switch. Sleep quality improved on switch off <jats:styled-content style="fixed-case">EFV</jats:styled-content> [mean <jats:styled-content style="fixed-case">PSQI</jats:styled-content> (standard deviation): <jats:styled-content style="fixed-case">EFV</jats:styled-content>, 8.5 (6.5); <jats:styled-content style="fixed-case">LPV</jats:styled-content>/r, 5.8 (5.5); mean difference −0.4; 95% confidence interval −6.0 to −0.7].</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This is the first study to assess the effects of chronic <jats:styled-content style="fixed-case">EFV</jats:styled-content> therapy on neurological function in a controlled setting. We conclude that <jats:styled-content style="fixed-case">EFV</jats:styled-content> withdrawal is unlikely to result in significant modification of neurocognitive function in otherwise stable <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐infected people.</jats:p></jats:sec>

• 出版日期2017-10