HIV-1-infection, Neurocognitive Dysfunction
Conditions
Keywords
HIV, Neurocognitive disorder, Efavirenz, Rilpivirine
Brief summary
People living with HIV in the era of antiretroviral therapy (ART) continue to suffer high rates of neurocognitive disorder. This is a randomized control trial aiming to evaluate improvement of neurocognitive function after switching efavirenz (EFV) to rilpivirine (RPV). EFV based regimen is currently the first line ART in Thailand. There are several reports suggested that HIV-infected patients who took EFV based regimen had poorer neurocognitive function compared to the comparator. RPV, another first line regimen, has been known to have less neuropsychiatric side effects. We hypothesized that switching EFV to RPV could improve neurocognitive function.
Detailed description
People living with HIV (PLWH) in the era of antiretroviral therapy (ART) continue to suffer high rates of neurocognitive disorder. Previous report revealed that 36% of PLWH in Thailand had this condition. There are several reports suggested that HIV-infected patients who took efavirenz (EFV) based regimen had poorer neurocognitive function compared to the comparator. Rilpivirine (RPV), another first line regimen, has been known to have less neuropsychiatric side effects. We hypothesized that switching EFV to RPV could improve long term neurocognitive function. PLWH (20 years and older) who received EFV-based regimen for at least 1 years at Chiang Mai University Hospital will be invited to this study. Neurocognitive function will be evaluated using 3 screening questions, International HIV Dementia Scale, Montreal Cognitive Assessment, and comprehensive neurocognitive battery test evaluating 6 different cognitive domains. The participants will be categorized in to 4 groups based on their neurocognitive test results; no evidence of neurocognitive deficit, asymptomatic neurocognitive impairment (ANI), mild neurocognitive disease (MND), and HIV associated dementia (HAD) using Frascati's criteria. The participants with ANI or MND and meet the eligibility criteria will be enrolled to this study. The participants will be randomized in to 2 arms; continuing EFV-based regimen or switching to RPV-based regimen. Neurocognitive function will be evaluated at 6 and 12 months.
Interventions
Rilpivirine 25 mg PO OD with meal (and continue 2 back bone of NRTIs)
Sponsors
Chiang Mai University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Documented HIV infection * Age 20 years old and above * On EFV-based regimen (EFV and 2 Nucleoside Reverse Transcriptase Inhibitors) for at least 1 year prior to enrollment * CD4 ≥ 200 cell/mm3 and viral load \< 200 copies/mL within 12 months before enrollment * Able to be read and write in Thai language * Willing to sign informed consent and able to follow up * The neurocognitive battery test is compatible with asymptomatic neurocognitive impairment (ANI) or mild neurocognitive disorder (MND) using Frascati's criteria
Exclusion criteria
* History of Traumatic Brain Injury, Developmental delay or intellectual deficit, or other neurological conditions have deleterious effects on neurocognitive test based on investigator opinion. * Active syphilis or on going to treatment with positive for syphilis serological marker (rapid plasma reagin; RPR) in 3 Months before entry study * Pregnancy * Renal failure (creatinine clearance \< 30 mL/min) * Transaminitis in the past 3 months (≥5 UNL) Or Decompensated cirrhosis (child-pugh C) * Moderate depressive score; Patient Health Questionnaire-9 score ≥ 10) * Positive for any hepatitis B virus and hepatitis C virus serological marker in 3 Months before entry study * History of treatment failure or drug resistance to EFV and or RPV * Not suitable or contraindication for RPV (continue proton pump inhibitor drug)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change of neurocognitive function | 12 months | Improvement is defined by changing neurocognitive status based on Frascati's criteria (using neurocognitive battery tests) 1) from Asymptomatic neurocognitive impairment (ANI) to normal OR 2) from Mild neurocognitive disorder; MND to ANI or normal. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Global Deficit Score of all neurocognitive domains | 12 months | All neurocognitive domains will be evaluated at 12 months after randomization which include; Verbal and language, Attention and working memory, Abstraction and executive function, Memory (learning, recall), Speed of information processing, and Sensory-perceptual and motor skills. The Global Deficit Score (min of 0, max of 5) of overall performance will be compared. |
| Adverse reactions after switching from EFV to RPV | 12 months | Adverse reactions of RPV will be recorded |
| Prevalence of neurocognitive disorder among HIV-infected patients who has received EFV for at least 1 year | 3 months | The prevalence of neurocognitive disorder (in percentage), will be evaluated among participants during the screening process. |
Countries
Thailand
Outcome results
None listed