Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control study
Heterogeneous neurocognitive impairment remains an important issue, even in the era of combination antiretroviral therapy (cART), with an incidence ranging from 15% to 65%. Although ART drugs with higher penetration scores to the central nervous system (CNS) show better HIV replication control in th...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-06-01
|
| Series: | Frontiers in Pharmacology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2023.1110605/full |
| _version_ | 1797809000092270592 |
|---|---|
| author | Chen-Hsing Chou Jian-Shiun Chiou Mao-Wang Ho Mao-Wang Ho Ni Tien Te-Mao Li Mu-Lin Chiu Fuu-Jen Tsai Fuu-Jen Tsai Fuu-Jen Tsai Fuu-Jen Tsai Yang-Chang Wu I-Ching Chou I-Ching Chou Hsing-Fang Lu Ting-Hsu Lin Chiu-Chu Liao Shao-Mei Huang Wen-Miin Liang Ying-Ju Lin Ying-Ju Lin |
| author_facet | Chen-Hsing Chou Jian-Shiun Chiou Mao-Wang Ho Mao-Wang Ho Ni Tien Te-Mao Li Mu-Lin Chiu Fuu-Jen Tsai Fuu-Jen Tsai Fuu-Jen Tsai Fuu-Jen Tsai Yang-Chang Wu I-Ching Chou I-Ching Chou Hsing-Fang Lu Ting-Hsu Lin Chiu-Chu Liao Shao-Mei Huang Wen-Miin Liang Ying-Ju Lin Ying-Ju Lin |
| author_sort | Chen-Hsing Chou |
| collection | DOAJ |
| description | Heterogeneous neurocognitive impairment remains an important issue, even in the era of combination antiretroviral therapy (cART), with an incidence ranging from 15% to 65%. Although ART drugs with higher penetration scores to the central nervous system (CNS) show better HIV replication control in the CNS, the association between CNS penetration effectiveness (CPE) scores and neurocognitive impairment remains inconclusive. To explore whether ART exposure is associated with the risk of neurological diseases among patients with HIV/AIDS, this study in Taiwan involved 2,571 patients with neurological diseases and 10,284 matched, randomly selected patients without neurological diseases between 2010 and 2017. A conditional logistic regression model was used in this study. The parameters for ART exposure included ART usage, timing of exposure, cumulative defined daily dose (DDD), adherence, and cumulative CPE score. Incident cases of neurological diseases, including CNS infections, cognitive disorders, vasculopathy, and peripheral neuropathy, were obtained from the National Health Insurance Research Database in Taiwan. Odds ratios (ORs) for the risk of neurological diseases were conducted using a multivariate conditional logistic regression model. Patients with a history of past exposure (OR: 1.68, 95% confidence interval [CI]:1.22–2.32), low cumulative DDDs (< 2,500) (OR: 1.28, 95% CI: 1.15–1.42), low adherence (0 < adherence (ADH) ≤ 0.8) (OR: 1.46, 95% CI: 1.30–1.64), or high cumulative CPE scores (>14) (OR: 1.34, 95% CI: 1.14–1.57) had a high risk of neurological diseases. When stratified by classes of ART drugs, patients with low cumulative DDDs or low adherence had a high risk of neurological diseases, including NRTIs, PIs, NNRTIs, INSTIs, and multi-drug tablets. Subgroup analyses also suggested that patients with low cumulative DDDs or low adherence had a high risk of neurological diseases when they had high cumulative CPE scores. Patients with high cumulative DDDs or medication adherence were protected against neurological diseases only when they had low cumulative CPE scores (≤ 14). Patients may be at risk for neurological diseases when they have low cumulative DDDs, low adherence, or usage with high cumulative CPE scores. Continuous usage and low cumulative CPE scores of ART drugs may benefit neurocognitive health in patients with HIV/AIDS. |
| first_indexed | 2024-03-13T06:47:02Z |
| format | Article |
| id | doaj.art-1c4a3f5665c54bf0897107906d9a4d15 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-03-13T06:47:02Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-1c4a3f5665c54bf0897107906d9a4d152023-06-08T05:30:40ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122023-06-011410.3389/fphar.2023.11106051110605Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control studyChen-Hsing Chou0Jian-Shiun Chiou1Mao-Wang Ho2Mao-Wang Ho3Ni Tien4Te-Mao Li5Mu-Lin Chiu6Fuu-Jen Tsai7Fuu-Jen Tsai8Fuu-Jen Tsai9Fuu-Jen Tsai10Yang-Chang Wu11I-Ching Chou12I-Ching Chou13Hsing-Fang Lu14Ting-Hsu Lin15Chiu-Chu Liao16Shao-Mei Huang17Wen-Miin Liang18Ying-Ju Lin19Ying-Ju Lin20PhD Program for Health Science and Industry, College of Health Care, China Medical University, Taichung, TaiwanPhD Program for Health Science and Industry, College of Health Care, China Medical University, Taichung, TaiwanSection of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, TaiwanDepartment of Internal Medicine, School of Medicine, China Medical University, Taichung, TaiwanDepartment of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, TaiwanSchool of Chinese Medicine, China Medical University, Taichung, TaiwanSchool of Chinese Medicine, China Medical University, Taichung, TaiwanSchool of Chinese Medicine, China Medical University, Taichung, TaiwanGenetic Center, Department of Medical Research, China Medical University Hospital, Taichung, TaiwanDepartment of Biotechnology and Bioinformatics, Asia University, Taichung, TaiwanDepartment of Pediatrics, China Medical University Children’s Hospital, Taichung, TaiwanGraduate Institute of Integrated Medicine, China Medical University, Taichung, TaiwanDepartment of Pediatrics, China Medical University Children’s Hospital, Taichung, TaiwanGraduate Institute of Integrated Medicine, China Medical University, Taichung, TaiwanGenetic Center, Department of Medical Research, China Medical University Hospital, Taichung, TaiwanGenetic Center, Department of Medical Research, China Medical University Hospital, Taichung, TaiwanGenetic Center, Department of Medical Research, China Medical University Hospital, Taichung, TaiwanGenetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan0Department of Health Services Administration, China Medical University, Taichung, TaiwanSchool of Chinese Medicine, China Medical University, Taichung, TaiwanGenetic Center, Department of Medical Research, China Medical University Hospital, Taichung, TaiwanHeterogeneous neurocognitive impairment remains an important issue, even in the era of combination antiretroviral therapy (cART), with an incidence ranging from 15% to 65%. Although ART drugs with higher penetration scores to the central nervous system (CNS) show better HIV replication control in the CNS, the association between CNS penetration effectiveness (CPE) scores and neurocognitive impairment remains inconclusive. To explore whether ART exposure is associated with the risk of neurological diseases among patients with HIV/AIDS, this study in Taiwan involved 2,571 patients with neurological diseases and 10,284 matched, randomly selected patients without neurological diseases between 2010 and 2017. A conditional logistic regression model was used in this study. The parameters for ART exposure included ART usage, timing of exposure, cumulative defined daily dose (DDD), adherence, and cumulative CPE score. Incident cases of neurological diseases, including CNS infections, cognitive disorders, vasculopathy, and peripheral neuropathy, were obtained from the National Health Insurance Research Database in Taiwan. Odds ratios (ORs) for the risk of neurological diseases were conducted using a multivariate conditional logistic regression model. Patients with a history of past exposure (OR: 1.68, 95% confidence interval [CI]:1.22–2.32), low cumulative DDDs (< 2,500) (OR: 1.28, 95% CI: 1.15–1.42), low adherence (0 < adherence (ADH) ≤ 0.8) (OR: 1.46, 95% CI: 1.30–1.64), or high cumulative CPE scores (>14) (OR: 1.34, 95% CI: 1.14–1.57) had a high risk of neurological diseases. When stratified by classes of ART drugs, patients with low cumulative DDDs or low adherence had a high risk of neurological diseases, including NRTIs, PIs, NNRTIs, INSTIs, and multi-drug tablets. Subgroup analyses also suggested that patients with low cumulative DDDs or low adherence had a high risk of neurological diseases when they had high cumulative CPE scores. Patients with high cumulative DDDs or medication adherence were protected against neurological diseases only when they had low cumulative CPE scores (≤ 14). Patients may be at risk for neurological diseases when they have low cumulative DDDs, low adherence, or usage with high cumulative CPE scores. Continuous usage and low cumulative CPE scores of ART drugs may benefit neurocognitive health in patients with HIV/AIDS.https://www.frontiersin.org/articles/10.3389/fphar.2023.1110605/fullantiretroviral therapyneurocognitive impairmentnested case-control studycumulative defined daily doseCNS penetration effectiveness score |
| spellingShingle | Chen-Hsing Chou Jian-Shiun Chiou Mao-Wang Ho Mao-Wang Ho Ni Tien Te-Mao Li Mu-Lin Chiu Fuu-Jen Tsai Fuu-Jen Tsai Fuu-Jen Tsai Fuu-Jen Tsai Yang-Chang Wu I-Ching Chou I-Ching Chou Hsing-Fang Lu Ting-Hsu Lin Chiu-Chu Liao Shao-Mei Huang Wen-Miin Liang Ying-Ju Lin Ying-Ju Lin Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control study Frontiers in Pharmacology antiretroviral therapy neurocognitive impairment nested case-control study cumulative defined daily dose CNS penetration effectiveness score |
| title | Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control study |
| title_full | Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control study |
| title_fullStr | Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control study |
| title_full_unstemmed | Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control study |
| title_short | Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control study |
| title_sort | association of combination antiretroviral therapy with risk of neurological diseases in patients with hiv aids in taiwan a nested case control study |
| topic | antiretroviral therapy neurocognitive impairment nested case-control study cumulative defined daily dose CNS penetration effectiveness score |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2023.1110605/full |
| work_keys_str_mv | AT chenhsingchou associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT jianshiunchiou associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT maowangho associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT maowangho associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT nitien associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT temaoli associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT mulinchiu associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT fuujentsai associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT fuujentsai associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT fuujentsai associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT fuujentsai associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT yangchangwu associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT ichingchou associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT ichingchou associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT hsingfanglu associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT tinghsulin associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT chiuchuliao associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT shaomeihuang associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT wenmiinliang associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT yingjulin associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy AT yingjulin associationofcombinationantiretroviraltherapywithriskofneurologicaldiseasesinpatientswithhivaidsintaiwananestedcasecontrolstudy |