Phillip Chan1,2, Bohyung Yoon3,4, Donn Colby3,4, Eugène Kroon1, Carlo Sacdalan1, Somchai Sriplienchan1, Suteeraporn Pinyakorn3,4, Jintanat Ananworanich5, Victor Valcour6, Sandhya Vasan3,4, Denise Hsu3,4, Nittaya Phanuphak1, Robert Paul7, Serena Spudich2. 1. SEARCH, Institute of HIV Research and Innovation, Bangkok, Thailand. 2. Department of Neurology, Yale School of Medicine, New Haven, CT, USA. 3. U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. 4. Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA. 5. Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands. 6. Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA. 7. Missouri Institute of Mental Health, University of Missouri-St. Louis, MO, USA.
Abstract
BACKGROUND: Efavirenz (EFV)- and Dolutegravir (DTG)-based antiretroviral therapy (ART) are the formerly and currently recommended regimen for treatment-naïve individuals with HIV-1. Whether they impact the immunological and neuropsychiatric profile differentially remains unclear. METHODS: This retrospective analysis included 258 participants in the RV254 acute HIV-1 infection (AHI) cohort. Participants initiated one of three ART regimens during AHI: EFV-based (n = 131), DTG-based (n = 92), or DTG intensified with maraviroc (DTG/MVC, n = 35). All regimens included two nucleoside reverse transcriptase inhibitors and were maintained for 96 weeks. CD4 + and CD8+ T-cell counts, mood symptoms, and performance on a 4-test neuropsychological battery (NPZ-4) were compared. RESULTS: At baseline, the median age was 26 years; 99% were male; 36% were enrolled during Fiebig stage I-II. Plasma viral suppression at weeks 24 and 96 was similar between the groups. Compared to the EFV group, the DTG group showed greater increments of CD4+ (p < 0.001) and CD8+ (p = 0.015) T-cell counts but similar increment in CD4/CD8 ratio at week 96. Improvement in NPZ-4 was similar between the two groups at week 24, but greater in the DTG group at week 96 (p = 0.005). Depressive mood and distress symptoms based on the Patient Health Questionnaire and distress thermometer were similar between the two groups at follow-up. Findings for the DTG/MVC group were comparable to those for the DTG group in comparison to the EFV group. CONCLUSIONS: Among individuals with AHI, 96 weeks of DTG-based ART was associated with greater increments of CD4 + and CD8+ T-cell counts, and greater improvement in cognitive performance.
BACKGROUND: Efavirenz (EFV)- and Dolutegravir (DTG)-based antiretroviral therapy (ART) are the formerly and currently recommended regimen for treatment-naïve individuals with HIV-1. Whether they impact the immunological and neuropsychiatric profile differentially remains unclear. METHODS: This retrospective analysis included 258 participants in the RV254 acute HIV-1 infection (AHI) cohort. Participants initiated one of three ART regimens during AHI: EFV-based (n = 131), DTG-based (n = 92), or DTG intensified with maraviroc (DTG/MVC, n = 35). All regimens included two nucleoside reverse transcriptase inhibitors and were maintained for 96 weeks. CD4 + and CD8+ T-cell counts, mood symptoms, and performance on a 4-test neuropsychological battery (NPZ-4) were compared. RESULTS: At baseline, the median age was 26 years; 99% were male; 36% were enrolled during Fiebig stage I-II. Plasma viral suppression at weeks 24 and 96 was similar between the groups. Compared to the EFV group, the DTG group showed greater increments of CD4+ (p < 0.001) and CD8+ (p = 0.015) T-cell counts but similar increment in CD4/CD8 ratio at week 96. Improvement in NPZ-4 was similar between the two groups at week 24, but greater in the DTG group at week 96 (p = 0.005). Depressive mood and distress symptoms based on the Patient Health Questionnaire and distress thermometer were similar between the two groups at follow-up. Findings for the DTG/MVC group were comparable to those for the DTG group in comparison to the EFV group. CONCLUSIONS: Among individuals with AHI, 96 weeks of DTG-based ART was associated with greater increments of CD4 + and CD8+ T-cell counts, and greater improvement in cognitive performance.