Cross-sectional and cumulative longitudinal central nervous system penetration effectiveness scores are not associated with neurocognitive impairment in a well treated aging human immunodeficiency virus-positive population in Switzerland. Open Forum Infectious Diseases
Santos et al. for the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) Study Group aimed to examine (1) the relationship between neurocognitive impairment (NCI) and cross-sectional central nervous system (CNS) penetration effectiveness (CPE) score (CPE score at the time of neurocognitive assessment) and then (2) the longitudinal relationship between NCI and cumulative CPE scores (a summary of CPE scores from the time of ART initiation to the time of neurocognitive assessment). The authors hypothesized that cumulative CPE score might better predict the presence of NCI than the cross-sectional CPE score.
In total, 981 patients were enrolled, all of whom underwent standardized neurocognitive assessment. Most patients were male (80%) and Caucasian (92%). Neurocognitive impairment was present in 40%: 27% with HIV-associated NCI (mostly asymptomatic neurocognitive impairment), and 13% with NCI related to other factors. None of the CPE scores, neither cross-sectional nor cumulative, was statistically significantly associated with NCI.
In conclusion, neither cross-sectional nor cumulative CPE scores were statistically significantly associated with NCI in this large patient cohort. The NAMACO study patients will be reassessed at 2 and 4 years post inclusion, and the effect of antiretroviral therapy regimens, and therefore CPE score, will be examined on the appearance, persistence, or resolution of NCI with time.