Neurocognitive disorders in HIV-infected patients on various antiretroviral therapy regimes
Currently, HIV-associated neurocognitive disorders predominate among nervous system disorders in HIV infection and are widespread despite antiretroviral therapy (ART). In this regard, studies on the development and severity of neurocognitive changes during ART using dolutegravir (DTG) or elsulfavirine (ESV) are relevant.Shuldyakov A.A., Sheshina N.A., Barylnik Yu.B., Filippova N.V., Artemenko S.A., Chernyshevskaya G.M.
Objective. Comparative analysis of the severity of neurocognitive disorders in HIV-infected individuals receiving ART including DTG and ESV.
Materials and methods. The medical records of 3,458 patients diagnosed with HIV infection at a regional AIDS center on ART with DTG or ESV were analyzed. 170 men and women with heterosexually transmitted HIV infection in the subclinical stage (3) and secondary disease stage (4A) who had been receiving initial ART for 4–6 months and had achieved clinical, virological, and immunological remission were selected. Subjects were divided into two groups based on the third drug in their regimen: DTG (Group 1, n = 87) or ESV (Group 2, n = 83). After obtaining informed consent, both groups underwent a clinical examination with a psychiatrist/psychologist using a battery of neurocognitive tests.
Results. The HIV-infected subjects were found to have asymptomatic and mild neurocognitive disorders. Nervous system changes were similar in severity and direction in both groups. Signs of depression were slightly less common in Group 2; the overall MoCA score was comparable to that of Group 1, and no impairments in attention or executive function were observed. Both groups demonstrated high adherence to medication therapy, which may be related to the design of the study.
Conclusion. In a comparative study, DTG and ESV demonstrated a relatively favorable safety profile with respect to the severity of neurocognitive disorders in HIV-infected patients, with parameters characterizing individual components of neurocognitive status being comparable in both groups. Overall, the problem of neurocognitive disorders in HIV-infected patients remains relevant, and a personalized approach to treating these patients using neuropsychological assessment will undoubtedly improve the quality and effectiveness of therapy.
Keywords
HIV infection
neurocognitive disorders
antiretroviral therapy
dolutegravir
elsulfavirine
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About the Authors
Professor Andrei A. Shuldyakov, MD, Head, Department of Infectious Diseases, V.I. Razumovsky Saratov State Medical University, Ministry of Health of the Russian Federation, Saratov, Russia; shuldaykov@mail.ru; https://orcid.org/0000-0002-3009-9262Natalia A. Sheshina, Assistant, Department of Infectious Diseases, V.I. Razumovsky Saratov State Medical University, Ministry of Health of the Russian Federation, Saratov, Russia; natalie.tuluza@yandex.ru; https://orcid.org/0009-0003-2279-5430
Professor Yulia B. Barylnik, MD, Head, Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, V.I. Razumovsky Saratov State Medical University, Ministry of Health of the Russian Federation, Saratov, Russia; juljab@yandex.ru; https://orcid.org/0000-0001-6837-5894
Natalya V. Filippova, Cand. Med. Sci., Associate Professor, Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Saratov State Medical University named after V.I. Razumovsky, Ministry of Health of the Russian Federation, Saratov, Russia; kafedra_psyhiatrii_sgmu@mail.ru; https://orcid.org/0000-0002-3380-5935
Sergey A. Artemenko, Chief Physician, Saratov Regional Clinical Center for AIDS Prevention and Control, Saratov, Russia; centr_spid@overta.ru; https://orcid.org/0009-0006-6213-7821
Galina M. Chernyshevskaya, Infectiologist, Head, Outpatient Department, Saratov Regional Clinical Center for AIDS Prevention and Control, Saratov, Russia; gallifax@mail.ru; https://orcid.org/0009-0004-1117-138X
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