CNS Penetration of ART and Cognitive Performance: An Unexpected Finding

HIV replication in the cerebrospinal fluid (CSF) is associated with severity of HIV-associated dementia. Previous studies have shown that antiretroviral drugs differ in their ability to penetrate the central nervous system (CNS) and suppress CSF viral load. Now, in ACTG 736, investigators have examined whether such penetration improves clinical outcome.

Patients were initiating a new antiretroviral therapy (ART) regimen or changing an existing regimen because of virologic failure; individual regimens reflected either primary provider choice or randomization arm in a clinical trial. To increase the likelihood of baseline neurocognitive impairment, participants also needed to have either a CD4 count <200 cells/mm³ and plasma HIV RNA >2000 copi…