HIV Antiretroviral Medication Neuropenetrance and Neurocognitive Outcomes in HIV+ Adults: A Review of the Literature Examining the Central Nervous System Penetration Effectiveness Score

• Published in: Viruses 2022-05, Vol.14 (6), p.1151
• Main Authors: Arentoft, Alyssa, Troxell, Katie, Alvarez, Karen, Aghvinian, Maral, Rivera Mindt, Monica, Cherner, Mariana, Van Dyk, Kathleen, Razani, Jill, Roxas, Michaela, Gavilanes, Melissa
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - pharmacology; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Antiviral agents; ARV medications; Brain research; Care and treatment; Central Nervous System; central nervous system penetration effectiveness; CNS; Cognition; Cognition - physiology; CPE; Diagnosis; Dosage and administration; Drug therapy; HIV; HIV infection; HIV Infections - complications; HIV Infections - drug therapy; HIV patients; Human immunodeficiency virus; Humans; Literature reviews; Methods; Morbidity; Nervous system; Neurologic manifestations of general diseases; neuropenetrance; Neuropsychological Tests; Neuropsychology; Plasma; Prevention; Review; Risk factors; Short term memory
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v14061151

This literature review summarizes the existing research examining the CNS penetration effectiveness (CPE) score and neurocognitive outcomes (i.e., neuropsychological assessment and neurocognitive screening) in HIV+ individuals. Despite the effectiveness of Combined Antiretroviral Therapy (CART) in reducing mortality and morbidity in HIV and controlling viral replication, HIV often persists in the Central Nervous System (CNS), and rates of neurocognitive impairment remain higher than predicted in the post-CART era. The CPE score was developed to rank antiretroviral regimens on their ability to penetrate the CNS and potency in inhibiting the virus, and it has been examined in relation to neurocognitive functioning for over a decade. Based on the results of 23 studies, we conclude that CPE is not as strongly associated with neurocognitive outcomes as initially hypothesized, although higher CPE ARV regimens may be associated with modest, improved outcomes in global neurocognitive functioning, and to a lesser extent attention/working memory and learning/memory. Conclusions, however, are limited by the heterogeneity in study design and methods, and the lack of a more recent CPE metric update. It is recommended that future research in this area employ comprehensive, standardized neuropsychological test batteries and examine domain-level performance, and use the newer 2010 CPE metric, although an updated CPE ranking is urgently needed.