401. Antiretroviral CNS Penetration Effectiveness Rank is Associated with HIV-Related Distal Sensory Polyneuropathy and Low Intraepidermal Nerve Fiber Density
Session: Poster Abstract Session: HIV - Antiretroviral Therapy
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • POSTER for IDSA.pdf (1.3 MB)
  • Background: CHARTER study provided a method for quantifying penetration of antiretroviral (ARV) drugs in the CNS, developing the CNS penetration-effectiveness (CPE) rank by algorithmically combining the individual drug rankings. CPE was associated with CSF viral load. Nevertheless, its association with neurocognitive disorders is ambivalent. The present study aimed to investigate whether the CPE rank might also associate with HIV-related distal sensory polyneuropathy (DSP)

    Methods: A total of 102 consecutive HIV patients of an outpatient clinic were submitted to clinical examination, electrophysiology, and intraepidermal nerve fiber density (IENFD) evaluation by skin biopsy for the presence of DSP. The HIV status, surrogate markers and antiretroviral history was recorded and the CPE rank of the current ARV regimen was calculated. Statistical analysis was executed using SPSS 15.0

    Results: Almost 16% presented with symptomatic DSP and another 36% demonstrated subclinical DSP, recognized by means of electrophysiology and/or IENFD determination. IENFD was associated with more advanced HIV disease, lower nadir CD4 count, and exposure to NRTIs. Mean CPE rank was 1.52±0.77. The CPE rank did not differ in patients with or without DSP. Using the cutoff value of CPE = 2, the regimen was characterized as CNS effective or not effective. Patients under CNS effective regimen were older (41.9±11.6 vs. 38.9±8.3 years, p=0.014), had lower values of IENFD in the calf (3.36±1.75 vs. 6.02±2.47, p=0.02) and worse DSP in terms of conduction velocity, vibration threshold and tendon reflexes. IENFD correlated with the CPE rank values (r=0.22, p=0.039)

    Conclusion: ARV therapy with increased CNS effectiveness was associated with worse measures of small and large fiber neuropathy, such as IENFD, electrophysiology and clinical findigs, probably attributed to increased age, ARV toxicity, metabolic complications or compartmentalization of HIN in the nervous system


    Subject Category: H. HIV/AIDS and other retroviruses

    Elias Skopelitis, MD1, Athanasios Kontos, MD2, George Panayiotakopoulos, MD3, Kyriaki Aroni, MD4, Panayiotis Kokotis, MD5, Kyriaki Panayiotopoulou6 and Theodore Kordossis, MD6, (1)Pathophysiology, Laikon General Teaching Hospital, Kifisia, Greece, (2)Laikon General Teaching Hospital, Kifisia, Greece, (3)Pharmacology, University of Patras, Athens, Greece, (4)Pathology, University of Athens, Athens, Greece, (5)Neurology, University of Athens, Athens, Greece, (6)Pathophysiology, Laikon General Teaching Hospital, Athens, Greece

    Disclosures:

    E. Skopelitis, None

    A. Kontos, None

    G. Panayiotakopoulos, None

    K. Aroni, None

    P. Kokotis, None

    K. Panayiotopoulou, None

    T. Kordossis, None

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