Neuropsychiatric outcomes before and after switching to dolutegravir-based therapy in an acute HIV cohort
Abstract Introduction Dolutegravir (DTG)-based antiretroviral therapy (ART) is currently the first-line treatment for people living with HIV. Neuropsychiatric adverse events (NP-AEs) have been reported with DTG but neuropsychiatric symptoms have not been systemically quantified using structured scal...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-01-01
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| Series: | AIDS Research and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12981-019-0257-8 |
| _version_ | 1828978409288499200 |
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| author | Phillip Chan Orlanda Goh Eugène Kroon Donn Colby Carlo Sacdalan Suteeraporn Pinyakorn Peeriya Prueksakaew Peter Reiss Jintanat Ananworanich Victor Valcour Serena Spudich Robert Paul the RV254/SEARCH 010 Research Team |
| author_facet | Phillip Chan Orlanda Goh Eugène Kroon Donn Colby Carlo Sacdalan Suteeraporn Pinyakorn Peeriya Prueksakaew Peter Reiss Jintanat Ananworanich Victor Valcour Serena Spudich Robert Paul the RV254/SEARCH 010 Research Team |
| author_sort | Phillip Chan |
| collection | DOAJ |
| description | Abstract Introduction Dolutegravir (DTG)-based antiretroviral therapy (ART) is currently the first-line treatment for people living with HIV. Neuropsychiatric adverse events (NP-AEs) have been reported with DTG but neuropsychiatric symptoms have not been systemically quantified using structured scales. This study examined mood and cognitive parameters before and after a planned transition from non-DTG to DTG-based ART within a longitudinal study of acute HIV infection (AHI). Methods RV254 AHI cohort participants on ≥ 24 weeks of ART initiated at AHI underwent sequential assessments before and after the switch including: (1) Patient Health Questionnaire-9 (PHQ-9), a 9-item survey (scores 0–27) that evaluates somatic and affective/cognitive symptoms of depression; (2) a 2-Questions screening that has been validated locally for depression; (3) Distress Thermometer (scores 0–10); and 4) administration of a 4-test neurocognitive battery sensitive to HIV. Results 254 individuals (95% male, median age 30) switched to a DTG-based regimen after a median 144 weeks of ART. Serial assessments were completed at a median of 19 weeks before and 37 weeks after DTG. There was a modest but statistically significant increase in PHQ-9 scores after DTG (pre-switch: 5 [IQR 1–7] vs. Post-switch: 5 [IQR 2–8], p = 0.009). The percentage of participants with at least moderate depression (PHQ-9 ≥ 10) increased from 10 to 16% (p = 0.006), but the frequency of moderate-severe depression (PHQ-9 ≥ 15) remained unchanged (3%). No volunteer reported NP-AEs within the study period. Somatic symptoms of depression increased more than cognitive/affective symptoms. Plasma viral suppression (HIV-1 RNA < 50; p = 0.005) and PHQ-9 ≥ 10 (p < 0.001) before switch were linked to lower PHQ-9 scores after DTG in multivariable analysis. Performance on all neuropsychological tests, except grooved pegboard test, improved modestly after DTG (all p < 0.05). Conclusion After a median duration of 37 weeks of DTG use, there was a modest increase in the higher quartile of PHQ-9. This increase was associated with a rise in moderate depression symptoms but not the more severe forms of depression on PHQ-9. No clinically relevant NP-AEs were reported. Pre-existing depression was not associated with subsequent worsening of symptoms after DTG. Cognitive test performance improved post-DTG but could be due to practice effect. |
| first_indexed | 2024-12-14T15:17:39Z |
| format | Article |
| id | doaj.art-5feb26ce2e334c718903dcc193ffe407 |
| institution | Directory Open Access Journal |
| issn | 1742-6405 |
| language | English |
| last_indexed | 2024-12-14T15:17:39Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
| record_format | Article |
| series | AIDS Research and Therapy |
| spelling | doaj.art-5feb26ce2e334c718903dcc193ffe4072022-12-21T22:56:16ZengBMCAIDS Research and Therapy1742-64052020-01-011711710.1186/s12981-019-0257-8Neuropsychiatric outcomes before and after switching to dolutegravir-based therapy in an acute HIV cohortPhillip Chan0Orlanda Goh1Eugène Kroon2Donn Colby3Carlo Sacdalan4Suteeraporn Pinyakorn5Peeriya Prueksakaew6Peter Reiss7Jintanat Ananworanich8Victor Valcour9Serena Spudich10Robert Paul11the RV254/SEARCH 010 Research TeamSEARCH, The Thai Red Cross AIDS Research CentreSEARCH, The Thai Red Cross AIDS Research CentreSEARCH, The Thai Red Cross AIDS Research CentreSEARCH, The Thai Red Cross AIDS Research CentreSEARCH, The Thai Red Cross AIDS Research CentreThe Henry M. Jackson Foundation for the Advancement of Military MedicineSEARCH, The Thai Red Cross AIDS Research CentreDepartment of Global Health, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Institute for Global Health and DevelopmentSEARCH, The Thai Red Cross AIDS Research CentreMemory and Aging Center, Department of Neurology, University of California San FranciscoCenter for Neuroepidemiology and Clinical Neurological Research, Yale UniversityMissouri Institute of Mental Health, University of Missouri-St. LouisAbstract Introduction Dolutegravir (DTG)-based antiretroviral therapy (ART) is currently the first-line treatment for people living with HIV. Neuropsychiatric adverse events (NP-AEs) have been reported with DTG but neuropsychiatric symptoms have not been systemically quantified using structured scales. This study examined mood and cognitive parameters before and after a planned transition from non-DTG to DTG-based ART within a longitudinal study of acute HIV infection (AHI). Methods RV254 AHI cohort participants on ≥ 24 weeks of ART initiated at AHI underwent sequential assessments before and after the switch including: (1) Patient Health Questionnaire-9 (PHQ-9), a 9-item survey (scores 0–27) that evaluates somatic and affective/cognitive symptoms of depression; (2) a 2-Questions screening that has been validated locally for depression; (3) Distress Thermometer (scores 0–10); and 4) administration of a 4-test neurocognitive battery sensitive to HIV. Results 254 individuals (95% male, median age 30) switched to a DTG-based regimen after a median 144 weeks of ART. Serial assessments were completed at a median of 19 weeks before and 37 weeks after DTG. There was a modest but statistically significant increase in PHQ-9 scores after DTG (pre-switch: 5 [IQR 1–7] vs. Post-switch: 5 [IQR 2–8], p = 0.009). The percentage of participants with at least moderate depression (PHQ-9 ≥ 10) increased from 10 to 16% (p = 0.006), but the frequency of moderate-severe depression (PHQ-9 ≥ 15) remained unchanged (3%). No volunteer reported NP-AEs within the study period. Somatic symptoms of depression increased more than cognitive/affective symptoms. Plasma viral suppression (HIV-1 RNA < 50; p = 0.005) and PHQ-9 ≥ 10 (p < 0.001) before switch were linked to lower PHQ-9 scores after DTG in multivariable analysis. Performance on all neuropsychological tests, except grooved pegboard test, improved modestly after DTG (all p < 0.05). Conclusion After a median duration of 37 weeks of DTG use, there was a modest increase in the higher quartile of PHQ-9. This increase was associated with a rise in moderate depression symptoms but not the more severe forms of depression on PHQ-9. No clinically relevant NP-AEs were reported. Pre-existing depression was not associated with subsequent worsening of symptoms after DTG. Cognitive test performance improved post-DTG but could be due to practice effect.https://doi.org/10.1186/s12981-019-0257-8DolutegravirNeuropsychiatric adverse eventsDepressionRV254Cognitive performance |
| spellingShingle | Phillip Chan Orlanda Goh Eugène Kroon Donn Colby Carlo Sacdalan Suteeraporn Pinyakorn Peeriya Prueksakaew Peter Reiss Jintanat Ananworanich Victor Valcour Serena Spudich Robert Paul the RV254/SEARCH 010 Research Team Neuropsychiatric outcomes before and after switching to dolutegravir-based therapy in an acute HIV cohort AIDS Research and Therapy Dolutegravir Neuropsychiatric adverse events Depression RV254 Cognitive performance |
| title | Neuropsychiatric outcomes before and after switching to dolutegravir-based therapy in an acute HIV cohort |
| title_full | Neuropsychiatric outcomes before and after switching to dolutegravir-based therapy in an acute HIV cohort |
| title_fullStr | Neuropsychiatric outcomes before and after switching to dolutegravir-based therapy in an acute HIV cohort |
| title_full_unstemmed | Neuropsychiatric outcomes before and after switching to dolutegravir-based therapy in an acute HIV cohort |
| title_short | Neuropsychiatric outcomes before and after switching to dolutegravir-based therapy in an acute HIV cohort |
| title_sort | neuropsychiatric outcomes before and after switching to dolutegravir based therapy in an acute hiv cohort |
| topic | Dolutegravir Neuropsychiatric adverse events Depression RV254 Cognitive performance |
| url | https://doi.org/10.1186/s12981-019-0257-8 |
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