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Even in this era of effective HIV treatment, the central nervous system (CNS) remains an ominous black box. Some data suggest that rates of HIV-associated neurologic disease are as high as ever, but clinicians seldom consider drug penetration into the CNS when devising treatment regimens. Should they?
As a first step to answering this question, investigators from a nationwide research consortium sought to determine whether drug penetration into the CNS correlated with detectable virus in cerebrospinal fluid (CSF). Of 467 patients on ART between 2003 and 2006, 29% were receiving PI-based regimens, 37% were receiving NNRTI-based regimens, and the rest were receiving 3-drug or 2-drug NRTI combinations, for a total of 166 different drug combinat…