Neurocognitive improvement in HIV-positive patients treated with dolutegravir-based regimens

BACKGROUND: Neurocognitive disorders due to human immunodeficiency virus (HIV) remain highly prevalent, specifically mild forms despite effective antiretroviral therapy (ART). Dolutegravir-based regimens are the first line of treatment for adult HIV-positive patients. Controversies exist regarding the neurocognitive effects of dolutegravir. Evidence regarding the neurocognitive effects of dolutegravir is important, in support of its use in patients with HIV-associated neurocognitive disorders (HAND). AIM: This study aimed to describe the change in cognitive function using the International HIV Dementia Scale (IHDS) and Brief Neuropsychological Cognitive Examination (BNCE) in HIV positive, treatment naïve patients before and 3 months after initiation of ART using a dolutegravir-based regimen. SETTING: The HIV initiation clinic of Hillbrow Community Health Centre in Johannesburg. METHODS: This prospective, quantitative cohort study assessed adult HIV-positive patients who were ART naïve being initiated on a dolutegravir-based regimen, using the BNCE and IHDS at baseline and after 3 months of treatment. RESULTS: Neurocognitive test results of 26 participants showed significant improvements for IHDS (Z = 1.84, p = 0.033) and time to complete BNCE (Z = 2.47, p = 0.007). BNCE total results showed improvements that were not significant (Z = 1.44, p = 0.075); however, Part 2 of the BNCE reflecting that of executive function showed significant improvements (Z = 66.5, p = 0.043). CONCLUSION: The trend of neurocognitive function is towards improvement in HIV-positive treatment naïve patients who receive 3 months of dolutegravir-based ART. CONTRIBUTION: The findings support the use of dolutegravir-based regimens in the treatment of patients with HIV-associated neurocognitive disorders. KEYWORDS: HIV-associated neurocognitive disorders; BNCE; IHDS; dolutegravir; neurocognitive screening; neurocognitive impairment; South Africa.