Survival after neuroAIDS Association with antiretroviral CNS Penetration-Effectiveness score

Objective: We examined if the CNS Penetration-Effectiveness (CPE) score of antiretroviral drugs was associated with survival after a diagnosis of HIV-related encephalopathy, progressive multifocal leukoencephalopathy (PML), cerebral toxoplasmosis, or cryptococcal meningitis. Methods: Using data from the FHDH-ANRS CO4, we compared the survival of 9,932 HIV-infected patients diagnosed with a first neurologic AIDS-defining event in the pre–combination antiretroviral therapy (cART) (1992–1995), early cART (1996–1998), or late cART (1999–2004) periods. Follow-up was subdivided (CPE Results: In the pre-cART and early cART periods, regimens with CPE ≥ 1.5 were associated with lower mortality after HIV-related encephalopathy (RR 0.64; 95% confidence interval [CI] 0.47–0.86 and RR 0.45; 95% CI 0.35–0.58) and after PML (RR 0.79; 95% CI 0.55–1.12 and RR 0.45; 95% CI 0.31–0.65), compared to regimens with CPE Conclusion: At the beginning of the cART era, the CPE score was of importance for survival after severe neurologic event, while in the late cART period, the additional effect of CPE score vanished with more powerful antiretroviral regimens associated with plasma viral load control.