20th International AIDS Conference - Melbourne, Australia


THAB0101 - Oral Abstract Session

Use of efavirenz is not associated to an increased risk of neurocognitive impairment in HIV-infected patients

Presented by Andrea Antinori (Italy).

C. Pinnetti1, P. Balestra1, R. Libertone1, P. Lorenzini1, A. Cozzi-Lepri2, A. Ammassari1, M. Ricottini1, M. Plazzi1, S. Menichetti1, V. Tozzi1, A. Antinori1

1National Institute for Infectious Disease, Rome, Italy, 2University College London, London, United Kingdom

Background: Efavirenz (EFV) can lead to neuropsychiatric symptoms, but the association between EFV use and the risk of neurocognitive impairment (NCI) remains controversial.
Methods: Single-centre, retrospective, cross-sectional analysis of neurocognitive profile in HIV-infected cART-treated patients. All patients underwent neuropsychological assessment (NPA) by standardized battery of 14 tests on 5 different domains. People were classified as having NCI if they scored ≥1 standard deviation (SD) below the normal mean in at least 2 tests, or≥2 SD below in 1 test. As additional binary outcome, HIV-associated neurocognitive disorders (HAND) were classified according to Frascati''s criteria. Logistic regression with robust standard error was fitted.
Results: 859 HIV-infected individuals cART-treated from 2000 to 2013, contributing a total of 1,020 NPA tests, were included (male 78%; IVDUs 19%; HCV+ 28%; median CD4 nadir 190/mm3; median current CD4 483/mm3; undetectable HIV-RNA in 69%). At the time of NPA, 324 (32%) patients were receiving an EFV-based cART; these were more likely to be male, MSM, CDC stage A/B, HCVAb-negative, with a higher nadir or current CD4 count, and were more frequently HIV-RNA undetectable. Prevalence of NCI did not differ in people receiving EFV or not (P=0.197). At multivariable logistic regression, age (OR: 1.37 per 10 years older), IVDU (OR: 1.77 vs MSM), CDC group C (OR: 1.74 vs. CDC A) were independently associated with an increased risk of NCI, whereas educational level (0.85 for each year of schooling) and CD4 >500/mm3 at NPA (0.68 vs. CD4 < =350) seemed to be protective. Current EFV was associated with a significantly decreased risk of NCI at univariable analysis (OR: 0.71 vs. off EFV ;95%CI: 0.54-0.94), but no longer significant after controlling for potential confounding (OR: 0.96 ;95%CI 0.69-1.35) (Figure). Gender, HCV+ serology, haemoglobin level, and 2010 CPE score were not associated with NCI.


Conclusions: In this large case series, EFV exposure was not associated with an increased risk of NCI. Even though confounding by indication may play a role, our results suggest that presence of NCI among persons treated with EFV-based cART may not occur more frequently than expected by chance.

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