Prediction of brain atrophy using three drug scores in neuroasymptomatic HIV-infected patients with controlled viremia

BACKGROUND: Despite potent antiretroviral therapy, HIV still causes brain damage. Better penetration into the CNS and efficient elimination of monocyte/macrophages reservoirs are two main characteristics of an antiretroviral drug that could prevent brain damage. The aim of our study was to assess efficacy of three antiretroviral drug scores to predict brain atrophy in HIV-infected patients. METHODS: A cross sectional study consisting of 56 HIV-infected patients with controlled viremia, who had no clinically evident neurocognitive impairment. All patients had MRI of the head. A typical T2 transversal slice was analyzed and ventricles–brain ratio (VBr) as an overall brain atrophy index was calculated. Three antiretroviral drug scores were used and correlated with VBr: 2008 and 2010 CNS penetration effectiveness scores (ΣCPE(2008) and ΣCPE(2010)) and the recently established monocyte efficacy (ΣME) score. A p-value <0.05 was considered significant. RESULTS: ΣCPE(2010) was significantly associated with VBr in both univariate (r = −0.285, p = 0.033) and multivariate (β = −0.299, p = 0.016) regression models, while ΣCPE(2008) was not (r = −0.141, p = 0.300 and β = −0.156, p = 0.214). ΣME was associated with VBr in multivariate model only (r = −0.297, p = 0.111 and β = −0.406, p = 0.029). Age and reported duration of HIV infection were also significant predictors of overall brain atrophy in multivariate regression models. CONCLUSIONS: Although based on similar type of research, ΣCPE(2010) is a superior drug score compared to ΣCPE(2008). ΣME is an efficient drug score in determining brain damage. Both ΣCPE(2010) and ΣME scores should be taken into account in preventive strategies of brain atrophy and neurocognitive impairment in HIV-infected patients.