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Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors
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Does efavirenz replacement improve neurological function in treated HIV infection?
B Payne1,2, T J Chadwick3, A Blamire4
1Department of Infection and Tropical Medicine, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
HIV Medicine
|March 2, 2017
Summary
Switching from efavirenz (EFV) to lopinavir/ritonavir (LPV/r) in HIV patients did not alter neurocognitive function. However, stopping EFV improved sleep quality, suggesting it may impact sleep rather than cognition.
Area of Science:
- Neuroscience
- Infectious Diseases
- Pharmacology
Background:
- The impact of specific antiretroviral drugs on cognitive function in people with HIV is not well understood.
- Efavirenz (EFV) is suspected to potentially cause cognitive impairment.
- This study investigates EFV's role in neurocognitive and neurometabolic function within HIV treatment.
Purpose of the Study:
- To determine if chronic efavirenz (EFV) therapy modifies neurocognitive and neurometabolic function in HIV-infected individuals on suppressive antiretroviral therapy.
- To assess the impact of switching from EFV to lopinavir/ritonavir (LPV/r) on cognitive function, brain metabolites, and brain activity.
- To evaluate changes in sleep quantity and quality after discontinuing EFV.
Main Methods:
- An open-label, phase IV controlled trial involving adult subjects on stable EFV therapy.
- Participants were switched from EFV to LPV/r, maintaining their nucleoside reverse transcriptase inhibitor (NRTI) backbone.
- Assessments included cognitive function (CogState), brain metabolites (MRS), brain activity (fMRI), and sleep parameters (diaries, PSQI, ESS) before and after the switch.
Main Results:
- No significant changes in cognitive function, brain metabolites, or brain activity were observed 10 weeks after switching from EFV to LPV/r.
- Despite 81% reporting baseline memory issues, neurocognitive outcomes remained stable.
- Sleep quality significantly improved after discontinuing EFV, with a reduction in the Pittsburgh Sleep Quality Index (PSQI) scores.
Conclusions:
- This is the first controlled study examining the neurological effects of chronic EFV therapy.
- EFV withdrawal is unlikely to significantly alter neurocognitive function in stable HIV-infected individuals.
- Discontinuing EFV may positively impact sleep quality in this population.
Keywords:
HIVcognitive impairmentefavirenzfunctional magnetic resonance imagingmagnetic resonance spectroscopyMore Related Videos
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