Integrase Strand Transfer Inhibitor Start or Switch Impacts Learning in Women With HIV
Year: 2020
Type: article
Abstract: BACKGROUND: Integrase strand transfer inhibitors (INSTIs) are first-line regimens for HIV treatment. We aimed to examine their impact on cognitive performance and depressive symptoms in women with HIV (WWH). SETTING: Women's Interagency HIV Study, a multisite, prospective, cohort study. METHODS: WWH who started or switched to INSTI-based antiretroviral therapy (ART) and completed neuropsychological testing and the Center for Epidemiological Studies-Depression (CES-D) scale before and after INSTI start/switch were included in the analyses. Primary outcomes were demographically corrected cognitive domain T-scores. Linear mixed-effects models adjusted for relevant covariates were used to examine effects of start/switch of any INSTI and individual INSTI drugs on cognition and CES-D scores. RESULTS: Six hundred thirty-nine WWH, median age 49 (interquartile range 12) years, 66% Black non-Hispanic, had neuropsychological and CES-D scale data before and after INSTI start/switch. Although 14% started INSTI-based ART, the remainder switched to INSTI-based ART from another regimen. Overall, any INSTI use was associated with poorer learning post-INSTI. Specifically, use of dolutegravir and elvitegravir, but not raltegravir, was associated with poorer learning. In analyses restricted to INSTI switch, any INSTI use, and dolutegravir use, was associated with poorer learning. Among those switching from a PI-based regimen, INSTIs overall and dolutegravir remained associated with poorer learning; switching from a nonnucleoside reverse transcriptase inhibitor to dolutegravir was also associated with poorer learning. INSTI start/switch was not related to depressive symptom changes. CONCLUSIONS: INSTI use was associated with poorer learning among WWH. These changes were mainly observed in elvitegravir and dolutegravir users, indicating that the impact of INSTI on cognition in WWH may not be a class effect.
Authors: Jane A. O'Halloran, Kunbo Wang, Amanda B. Spence, Dionna W. Williams, Raha Dastgheyb, Kathryn C. Fitzgerald, Asante R. Kamkwalala, Pauline M. Maki, Anjali Sharma, Deborah R. Gustafson, Joel Milam, Kathleen M. Weber, Adaora A. Adimora, Igho Ofotokun, Margaret A. Fischl, Deborah Konkle-Parker, Cecile D. Lahiri, Anandi N. Sheth, Yanxun Xu, Leah H. Rubin
Institutions: Washington University in St. Louis, Johns Hopkins University, Georgetown University, Johns Hopkins Medicine, University of Illinois Chicago, Albert Einstein College of Medicine, SUNY Downstate Health Sciences University, University of Southern California, Hektoen Institute, University of North Carolina at Chapel Hill, Grady Memorial Hospital, Emory University, Grady Health System, University of Miami, University of Mississippi Medical Center, Sidney Kimmel Comprehensive Cancer Center
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: National Science Foundation, Gilead Sciences, Johns Hopkins University, Georgia Clinical and Translational Science Alliance, National Institutes of Health, Center for AIDS Research, University of Washington, University of California, San Francisco, Center for AIDS Research, University of Alabama at Birmingham, National Institute on Alcohol Abuse and Alcoholism, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Human Genome Research Institute, National Cancer Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Dental and Craniofacial Research, National Center for Advancing Translational Sciences, Center for AIDS Research, University of North Carolina at Chapel Hill
Awards: G1002715558, G1913134163, G2483435703, Acute Effects of Cannabis on Cognition and Mobility in Older HIV-Infected and Uninfected Women", Defining Antiretroviral Pharmacology Within HIV-1 Reservoirs of Males and Females, G311558797, G3572819748, Cannabidiol and Macrophage Chronic Inflammation in a Virally Suppressed Rhesus Macaque Model, Collaborative Research: New Bayesian Methods for Modeling the Effect of Antiretroviral Drugs on Depressive Symptomatology in HIV Patients, G3869857964, Cocaine Use and HIV Antiretroviral Therapy Efficacy in the CNS, Clinical and Translational Science Institute, G5900455136, G6396423216, G6990385686, G7178514535, G775892330, G7807729167, COCAINE USE AND HIV ANTIRETROVIRAL THERAPY EFFICACY IN THE CNS, G9000080293, University of Pittsburgh MACS/WIHS CCS, MACS/WIHS -CCS, The Johns Hopkins Center for AIDS Research (JHU CFAR), SF Bay Area MACS/WIHS Combined Cohort Study, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies, Center for AIDS Research at Emory University, JHU Center for the Advancement of HIV Neurotherapeutics (JHU CAHN), Northwestern CORE Clinical Research Site: Trans-omics for HIV/AIDS Research, Los Angeles CRS for the MACS/WIHS Combined Cohort Study, Data Analysis and Coordination Center for the MACS-WIHS Combined Cohort Study, MACS/WIHS Combined Cohort Study: Cook County Clinical Research Site (CC_CRS), The University of North Carolina Center for AIDS Research, MACS/WIHS Combined Cohort Study: Brooklyn Clinical Research Site (Bklyn CRS), Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS) - Baltimore/Wash DC Center, Sustained Training in Aging and HIV Research (STAHR), Atlanta MACS/WIHS Combined Cohort Study Clinical Research Site, UAB-MISS MACS/WIHS Combined Cohort Study, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR)
OpenAlex ID: W3114798311