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Neurocognition with maraviroc compared with tenofovir in HIV

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Objective:

The objective was to determine whether maraviroc (MVC) has unique neurocognitive benefits in the context of initial antiretroviral therapy (ART).

Design:

Randomized, double-blind, placebo-controlled, 48-week trial.

Setting:

Participants were enrolled in US AIDS Clinical Trials Group clinical trial sites.Participants:

Total 262 ART-naive, chemokine coreceptor 5 tropic HIV, and HIV RNA greater than 1000 copies/ml participants were randomized, 230 participants completed the study.


Intervention:

Participants received MVC 150 mg or tenofovir disoproxil fumarate (TDF) 300 mg on a background of ritonavir-boosted darunavir and emtricitabine.

Main outcome measure(s):

The neuropsychological battery of 15 tests done at baseline, week 24 and week 48 assessed seven domains, and were standardized into z-scores then converted into deficit scores and a global deficit score. The 48-week changes from baseline in the neuropsychological scores and the global deficit score were compared by Wilcoxon or Kruskal–Wallis test between arms, and among baseline impairment groups [classified as normal, mild (2 deficit scores ≥1) and moderate (2 deficit scores ≥2)]. It was hypothesized that the MVC arm would have improved neuropsychological performance over TDF.Results:

In this double-blind, randomized, placebo-controlled trial, there were no differences in neuropsychological performance between MVC and TDF. Those with moderate neuropsychological impairment at baseline experienced greater ART-mediated neuropsychological improvement than those with mild or no neuropsychological impairment.
Conclusion:

Improvement in neurocognitive functioning was greater with more baseline impairment but was comparable with MVC or TDF.
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Keywords: HIV-associated neurocognitive disorders; central nervous system; maraviroc; neurocognitive; neuropathogenesis; tenofovir

Document Type: Research Article

Affiliations: 1: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 2: Harvard University, Boston, Massachusetts 3: Johns Hopkins Hospital, Baltimore, Maryland 4: Northwestern University, Chicago, Illinois 5: Frontier Science & Technology, Amherst, New York, USA.

Publication date: September 24, 2016

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