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Abstract
Objective: To evaluate the efficacy and safety of minocycline in the management of HIV-associated cognitive impairment.
Methods: We enrolled HIV-positive participants with a CD4 count of 250 to 500 cells/μL in a randomized, double-blind, placebo-controlled study. They received 100 mg of minocycline or matching placebo orally every 12 hours for 24 weeks. Cognitive function was measured using the Uganda Neuropsychological Test Battery Summary Measure (U NP Sum) and the Memorial Sloan-Kettering (MSK) scale. The primary efficacy measure was the 24-week change in an average of 9 standardized U NP Sum z scores.
Results: Seventy-three participants were enrolled. Of these, 90% were female, 49% were between the ages 30 and 39 years, and 74% had 6 or more years of education. One participant had MSK score of stage 1 (i.e., mild HIV dementia), and 72 participants had MSK stage 0.5 (i.e., equivocal or subclinical dementia) at the baseline evaluation. The minocycline effect on the 24-week change of the U NP Sum compared with placebo was 0.03 (95% confidence interval −0.51, 0.46; p = 0.37).
Conclusion: Minocycline was safe and well tolerated in HIV-positive individuals. However, it did not improve HIV-associated cognitive impairment.
Classification of evidence: This study provides Class II evidence that 100 mg of minocycline given orally every 12 hours for 24 weeks had no significant effect compared with placebo in the improvement of cognitive function in antiretroviral therapy–naive, HIV-positive patients.
GLOSSARY
- cART=
- combination antiretroviral therapy;
- CI=
- confidence interval;
- DSMB=
- Data Safety and Monitoring Board;
- IADL=
- Instrumental Activities of Daily Living;
- RCI=
- reliable change index;
- U NP Sum=
- Uganda Neuropsychological Test Battery Summary Measure;
- WHO-UCLA=
- World Health Organization–University of California at Los Angeles
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received April 21, 2012.
- Accepted August 27, 2012.
- © 2013 American Academy of Neurology
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