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Switching from a regimen containing abacavir/lamivudine or emtricitabine/tenofovir disoproxil fumarate to emtricitabine/tenofovir alafenamide fumarate does not affect central nervous system HIV-1 infection

Journal article
Authors Aylin Yilmaz
Mellgren, Mellgren,
D. Fuchs
Staffan Nilsson
Kaj Blennow
Henrik Zetterberg
Magnus Gisslén
Published in Infectious Diseases
Volume 51
Issue 11-12
Pages 838-846
ISSN 2374-4235
Publication year 2019
Published at Department of Mathematical Sciences
Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Institute of Biomedicine, Department of Infectious Medicine
Pages 838-846
Language en
Keywords HIV-1, central nervous system, cerebrospinal fluid, neopterin, NFL, tenofovir alafenamide fumarate, reverse-transcriptase inhibitor, neurofilament protein nfl, cerebrospinal-fluid, antiretroviral treatment, tenofovir alafenamide, myocardial-infarction, immune activation, abacavir, risk, inflammation, Infectious Diseases
Subject categories Infectious Medicine


Background: Despite suppressive antiretroviral therapy (ART), many HIV-infected individuals have low-level persistent immune activation in the central nervous system (CNS). There have been concerns regarding the CNS efficacy of tenofovir alafenamide fumarate (TAF) because of its low cerebrospinal fluid (CSF) concentrations and because it is a substrate of the active efflux transporter P-glycoprotein. Our aim was to investigate whether switching from emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) or abacavir (ABC)/lamivudine (3TC) to FTC/TAF would lead to changes in residual intrathecal immune activation, viral load, or neurocognitive function. Methods: Twenty HIV-1-infected neuro-asymptomatic adults (11 on ABC/3TC and 9 on FTC/TDF) were included in this prospective study. At baseline, all participants changed their nucleoside analogues to FTC/TAF without any other changes in their ART regimen. We performed lumbar punctures, venipunctures, and neurocognitive testing at baseline and after three and 12 months. Results: During follow-up, there were no significant changes in CSF or plasma HIV RNA, CSF neopterin, CSF β2-microglobulin, IgG index, albumin ratio, CSF NFL, or neurocognitive function in assessed by Cogstate in any of the groups. Conclusion: This small pilot study indicates that switching to FTC/TAF from ABC/3TC or FTC/TDF has neither a positive, nor a negative effect on the HIV infection in the CNS.

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