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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Antiretroviral therapy CNS penetration and HIV-1-associated CNS disease
Neurology, Volume 76, No. 8, Year 2011
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Description
OBJECTIVE: The impact of different antiretroviral agents on the risk of developing or surviving CNS disease remains unknown. The aim of this study was to investigate whether using antiretroviral regimens with higher CNS penetration effectiveness (CPE) scores was associated with reduced incidence of CNS disease and improved survival in the UK Collaborative HIV Cohort (CHIC) Study. METHODS: Adults without previous CNS disease, who commenced combination antiretroviral therapy (cART) between 1996 and 2008, were included (n = 22,356). Initial and most recent cART CPE scores were calculated. CNS diseases were HIV encephalopathy (HIVe), progressive multifocal leukoencephalopathy (PML), cerebral toxoplasmosis (TOXO), and cryptococcal meningitis (CRYPTO). Incidence rates and overall survival were stratified by CPE score. A multivariable Poisson regression model was used to identify independent associations. RESULTS: The median (interquartile range) CPE score for initial cART regimen increased from 7 (5-8) in 1996-1997 to 9 (8-10) in 2000-2001 and subsequently declined to 6 (7-8) in 2006-2008. Differences in gender, HIV acquisition risk group, and ethnicity existed between CPE score strata. A total of 251 subjects were diagnosed with a CNS disease (HIVe 80; TOXO 59; CRYPTO 56; PML 54). CNS diseases occurred more frequently in subjects prescribed regimens with CPE scores ≤4, and less frequently in those with scores ≥10; however, these differences were nonsignificant. Initial and most recent cART CPE scores ≤4 were independently associated with increased risk of death. CONCLUSION: Clinical status at time of commencing cART influences antiretroviral selection and CPE score. This information should be considered when utilizing CPE scores for retrospective analyses. ©2011 American Academy of Neurology.
Authors & Co-Authors
Garvey, Lucy J.
United Kingdom, London
Imperial College London
United Kingdom, London
Imperial College Healthcare Nhs Trust
Winston, Alan
United Kingdom, London
Imperial College London
United Kingdom, London
Imperial College Healthcare Nhs Trust
Walsh, John Christopher
United Kingdom, London
Imperial College Healthcare Nhs Trust
Post, Frank A.
United Kingdom, London
King's College London
Porter, Kholoud
United Kingdom, London
Mrc Clinical Trials Unit
Gazzard, Brian George L.
United Kingdom, London
Chelsea and Westminster Hospital
Fisher, Martin J.
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Leen, Clifford L.S.
United Kingdom, Edinburgh
Western General Hospital
Morris, Lynn G.
United Kingdom, London
University College London
Hill, Teresa
United Kingdom, London
Ucl Medical School
Johnson, Margaret A.
United Kingdom, London
The Royal Free Hospital
Gilson, Richard John Cary
United Kingdom, London
Ucl Medical School
Anderson, Jane
United Kingdom, London
Homerton University Hospital Nhs Foundation Trust
Easterbrook, Philippa Jane
United Kingdom, London
King's College London
Bansi-Matharu, Loveleen K.
United Kingdom, London
Ucl Medical School
Orkin, Chloë M.
United Kingdom, London
Barts Health Nhs Trust
Ainsworth, Jonathan G.
United Kingdom, London
North Middlesex University Hospital Nhs Trust
Palfreeman, Adrian J.
United Kingdom, Leicester
University Hospitals of Leicester Nhs Trust
Gompels, Mark M.
United Kingdom, Bristol
Southmead Hospital Bristol
Phillips, Andrew N.
United Kingdom, London
Ucl Medical School
Sabin, Caroline Anne
United Kingdom, London
Ucl Medical School
Statistics
Citations: 47
Authors: 21
Affiliations: 15
Identifiers
Doi:
10.1212/WNL.0b013e31820d8b0b
ISSN:
1526632X
Research Areas
Infectious Diseases
Study Design
Cohort Study