mental health AIDS

Summer 2008 Newsletter / Volume 9, Issue 4

HIV Treatment News

Medical Care

Sinclair et al. (2008) set out to "define the effect of antiretroviral therapy (ART) on activation of T cells in cerebrospinal fluid (CSF) and blood, and interactions of this activation with CSF HIV-1 RNA concentrations" (p. 544) among men and women living with HIV. To do this, the investigators conducted "a cross-sectional study comparing 4 subject groups: (1) [53] HIV-1-infected subjects taking no ART for at least 3 months, referred to as 'offs'; (2) [30] infected subjects on stable combination ART for at least 3 months with plasma HIV-1 RNA levels > 500 copies/mL ('failures')3; (3) [40] infected subjects also on stable combination ART for at least 3 months, but with plasma HIV-1 RNA levels < 500 copies/mL ('successes'); and (4) [14] HIV-1-uninfected volunteers who served as controls (HIV negatives)" (p. 545).

Across the four groups, study participants were similar in terms of age, gender, and education. Moreover, the "ongoing antiretroviral drug regimens of the 2 treatment groups were not different with respect to the number and class of combination therapies except for greater use of nonnucleoside reverse transcriptase inhibitors in the successes. Likewise, ... the 2 treated groups did not differ in the number of CNS [(central nervous system)]-penetrating drugs or in the duration of therapy[.] ... [Importantly, n]one of the subjects suffered ongoing neurological disease" (p. 546).

As recounted in a summary of this study on the POZ magazine Web site (2008), Sinclair and colleagues found that

[alt]hough the offs and failures had similar levels of HIV in blood, levels of HIV in the CSF were significantly lower in the failures than the offs. When Sinclair's team looked for signs of immune activation ..., they found that remaining on a failing regimen reduced the amount of activation in both the blood and the brain. The offs had activation levels in both blood and CSF that were roughly double that of the HIV negatives. Immune activation was significantly lower in the failures and lower still in the successes. As would be expected, the HIV-negative group had the lowest levels of immune activation of all the groups.

In short, "[d]espite having similar levels of HIV in the blood, people who continue taking a failing antiretroviral ... regimen have lower levels of HIV and reduced immune activation in the brain compared with people not on treatment ... . This is potentially good news for people who may be at risk for HIV-related brain disorders like AIDS dementia complex" (POZ, 2008). As described by POZ, "Sinclair and her team conclude that while the results of their study are promising, similar research should be carried out in people with varying levels of neurological impairment to determine how much of a role immune activation and HIV levels in CSF play in brain disorders."

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 3 More precisely, it is the medication that failed the study subjects, not the study subjects themselves who failed.

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