Should We Optimize Antiretroviral CNS Penetration for Patients with HIV-Associated Neurologic Disease?

We know that antiretroviral drugs penetrate into the brain quite differently, and case reports have suggested that optimizing the central nervous system (CNS) penetration of a regimen may improve HIV-affected cognition. Still, formal studies of this strategy have yielded mixed results.

Researchers designed a large, multicenter, randomized trial to evaluate the efficacy of treating patients with HIV-associated cognitive disorder (HAND) preferentially with “high CNS penetration” drugs. After 4 years, 326 individuals had been screened but only 59 had enrolled, and a monitoring board recommended termination on the basis of slow accrual.

The 49 individuals with HAND who completed study week 16 were either antiretroviral therapy (ART) naive and ini…