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Issue No. 36 | September 4, 2009

News and Features

Increased Rates of HIV-associated Dementia Linked to HIV Subtype

“The subtype of HIV a person has may determine their odds for progressing to AIDS-linked dementia, Johns Hopkins researchers report.

“Cognitive difficulties, even dementia, are a common hallmark of HIV infection. But during their work in Africa, researchers led by Dr. Ned Sacktor noted that people in areas where HIV subtypes A and D were predominant seemed to have especially high rates of dementia….

“Reporting in the September issue of Clinical Infectious Diseases, the team found that seven of 33 patients with HIV subtype A had dementia (24 percent), but of the nine patients infected with subtype D, eight had dementia (89 percent)….

 “The researchers speculated that some biological property -- such as an increased ability of the virus to cause inflammation or injury in the brain -- may cause certain subtypes of HIV to lead to dementia more often. An investigation to determine whether that might be the case is currently underway, they said.”

To learn more about the link between HIV subtypes and dementia:

Kidney Function in First-Line Tenofovir-Containing Regimens

“[This study examined] whether tenofovir disoproxil fumarate (TDF) is associated with renal dysfunction when used as part of an initial antiretroviral regimen and … the effect of ritonavir-boosted protease inhibitor (PI/r) coadministration on renal function in TDF-treated patients …

“We compared … antiretroviral-naive patients … who initiated either TDF (n = 201) or any alternative nucleoside reverse transcriptase inhibitor (NRTI) (n = 231) after 1 January 2002 …

“Patients taking both TDF and NRTIs experienced an initial decline in eGFR [estimated glomerular filtration rate, a measure of kidney function] during the first 180 days of therapy, but eGFR stabilized between 180 and 720 days … There was no difference in median GFR decline between those on an NRTI and PI/r vs. an NRTI and non-NRTI….

“Our data are consistent with results of clinical trials, which have shown no evidence of renal toxicity when TDF is used as part of an initial regimen. Our results support the use of TDF as a component of the initial antiretroviral regimen, and suggest that the eGFR should be monitored more closely when TDF is used with a PI/r.”

More information is available: