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Neurocognition with maraviroc compared with tenofovir in HIV.

Neurocognition with maraviroc compared with tenofovir in HIV.
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Robertson KR, Miyahara S, Lee A, Brown TT, Chan ES, Berzins B, Rusin D, Eron JJ, Taiwo BO, ,


Robertson KR, Miyahara S, Lee A, Brown TT, Chan ES, Berzins B, Rusin D, Eron JJ, Taiwo BO, , (click to view)

Robertson KR, Miyahara S, Lee A, Brown TT, Chan ES, Berzins B, Rusin D, Eron JJ, Taiwo BO, ,

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AIDS (London, England) 30(15) 2315-21 doi 10.1097/QAD.0000000000001189

Abstract
OBJECTIVE
The objective was to determine whether maraviroc (MVC) has unique neurocognitive benefits in the context of initial antiretroviral therapy (ART).

DESIGN
Randomized, double-blind, placebo-controlled, 48-week trial.

SETTING
Participants were enrolled in US AIDS Clinical Trials Group clinical trial sites.

PARTICIPANTS
Total 262 ART-naive, chemokine coreceptor 5 tropic HIV, and HIV RNA greater than 1000 copies/ml participants were randomized, 230 participants completed the study.

INTERVENTION
Participants received MVC 150 mg or tenofovir disoproxil fumarate (TDF) 300 mg on a background of ritonavir-boosted darunavir and emtricitabine.

MAIN OUTCOME MEASURE(S)
The neuropsychological battery of 15 tests done at baseline, week 24 and week 48 assessed seven domains, and were standardized into z-scores then converted into deficit scores and a global deficit score. The 48-week changes from baseline in the neuropsychological scores and the global deficit score were compared by Wilcoxon or Kruskal-Wallis test between arms, and among baseline impairment groups [classified as normal, mild (2 deficit scores ≥1) and moderate (2 deficit scores ≥2)]. It was hypothesized that the MVC arm would have improved neuropsychological performance over TDF.

RESULTS
In this double-blind, randomized, placebo-controlled trial, there were no differences in neuropsychological performance between MVC and TDF. Those with moderate neuropsychological impairment at baseline experienced greater ART-mediated neuropsychological improvement than those with mild or no neuropsychological impairment.

CONCLUSION
Improvement in neurocognitive functioning was greater with more baseline impairment but was comparable with MVC or TDF.

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