Driving Skills in HIV-Infected Patients Well Controlled with Antiretroviral Therapy

Carlos Tornero, Inmaculada Poquet, Marine Bourguet, Fernando Gomis-Pajares

Ana Ventura, Maricarmen Mafé, Internal Medicine Department, Hospital Francisco de Borja, Gandia, Espa?a.
Preventive Service, Hospital Francisco de Borja, Gandia, Espa?a.

DOI: 10.4236/wja.2012.23017                

Abstract

A study was made to determine whether HIV-infected patients with prolonged virological control suffer subclinical neurocognitive problems capable of interfering with driving skills, compared with the general population, and to explore the possible existence of differences between those treated with and without efavirenz. Material and Methods: We included 40 patients without history of neoplasm, psychiatric disorders or infections of the central nervous system associated or not to HIV, with stable and effective antiretroviral therapy during at least 48 months. Use was made of the ASDE DRIVER TEST N-845 standardized by the Spanish traffic authorities, and for which data corresponding to the Spanish general population were obtained from the manufacturer of the test battery. The Student t-test was used to compare the different variables with the population standards, and the comparison of proportions Z-statistic was used to determine the proportion of subjects above the accepted limit of normality cutoff point. These analyses were replicated for the two sub-samples (with or without efavirenz therapy), with a 95% confidence level. The SPSS version 15 statistical package and Epidat 3.1 program were used. Results: The scores obtained in the HIV group were significantly poorer in the anticipation speed tests and in one of the multiple reactions test, though better results were obtained in the bimanual visual-motor coordination test. There were no differences in the percentages of patients with scores below the recommended limits. On comparing the treatment subgroups (efavirenz versus protease inhibitor), no differences were recorded in any of the study variables, and the differences with respect to the general population were the same as those described for the global group. Conclusions: Little differences were observed in driving skills in HIV well controlled HIV patients of minor clinical significance, and no differences were found in driving skills between the patients administered Efavirenz and those receiving protease inhibitor treatments.

Keywords

Driving Skills; Efavirenz; Neurocognitive Disorders

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. B. Clifford, S. Evans, Y. Yang, E. P. Acosta, K. Goodkin and K. Tashima, “Impact of Efavirenz on Neuropsychological Performance and Symptoms in HIV Infected Individuals,” Annals of Internal Medicine, Vol. 143, No. 10, 2005, pp. 714-721.
[2]	T. Hawkins, C. Geist, B. Young, A. Giblin, R. C. Mercier, K. Thornton, et al., “Comparison of Neuropsychiatric Side Effects in an Observational Cohort of Efavirenz- and Protease Inhibitor-Treated Patients,” HIV Clinical Trials, Vol. 6, 2005, pp. 187-196. doi:10.1310/92VR-FP24-J8GA-B49Q
[3]	C. R. Fumaz, J. A. Munoz-Moreno, J. Moltó, E. Negredo, M. J. Ferrer, G. Sirera, et al., “Long-Term Neuropsychiatric Disorders on Efavirenz-Based Approaches: Quality of Life, Psychologic Issues, and Adherence,” Journal of Acquired Immune Deficiency Syndromes, Vol. 38, No. 5, 2005, pp. 560-565. doi:10.1097/01.qai.0000147523.41993.47
[4]	R. K. Heaton, D. B. Clifford, D. R. Franklin Jr., S. P. Woods, C. Ake, et al., “HIV-Associated Neurocognitive Disorders Persist in the Era of Potent Antiretroviral Therapy CHARTER Study,” Neurology, Vol. 75, No. 23, 2010, pp. 2087-2096. doi:10.1212/WNL.0b013e318200d727
[5]	S. Simioni, M. Cavassini, J. M. Annoni, A. R. Abraham, I. Bourquin, V. Schiffer, A. Calmy, J. P. Chave, E. Giacobini, B. Hirschel and R. A. Du Pasquier, “Cognitive Dysfunction in HIV Patients Despite Long-Standing Suppression of Viremia,” AIDS, Vol. 24, No. 9, 2010, pp. 1243-1250.
[6]	T. D. Marcotte, T. Wolfson, T. J. Rosenthal, R. K. Heaton, R. Gonzalez, R. J. Ellis and I. Grant, “HIV Neurobehavioral Research Center Group A Multimodal Assessment of Driving Performance in HIV Infection,” Neurology, Vol. 63, No. 8, 2004, pp. 1417-1422. doi:10.1212/01.WNL.0000141920.33580.5D
[7]	T. D. Marcotte, D. Lazzaretto, J. C. Scott, E. Roberts, S. P. Woods, S. Letendre and HNRC Group, “Visual Attention Deficits Are Associated with Driving Accidents in Cognitively-Impaired HIV-Infected Individuals,” Journal of Clinical and Experimental Neuropsychology, Vol. 28, No. 1, 2006, pp. 13-28. doi:10.1080/13803390490918048
[8]	H. Monterde, “Real Decreto 772/97 ASDE Driver-Test N-845,” Examen Psicológico de Conductores en Espa?a con Equipos Normalizados, 2005.
[9]	D. Badenes Guia, “Discriminación de la Valoración de la Capacidad de Conducción de Vehículos en Personas con Diagnóstico de Deterioro Cognitivo Ligero y Demencia en los Exámenes de Conducción Normalizados,” MAPFRE Medicina, Vol. 8, No. 2, 2007, pp. 98-107.
[10]	C. Tornero, A. Ventura, M. Bourguet and I. Poquet, “Evaluation of Driving Ability among Residents after the Duty Shift,” Accident Analysis & Prevention, Vol. 7, 2012, pp. 182-183. doi:10.1016/j.aap.2012.01.007
[11]	M. Gisslén, W. Richard, R. W. Price and S. Nilsson III, “The Definition of HIV-Associated Neurocognitive Disorders: Are We Overestimating the Real Prevalence?” BMC Infectious Diseases, Vol. 11, 2011, pp. 356-360. doi:10.1186/1471-2334-11-356
[12]	C. Torti, E. Foca, B. M. Cesana and F. X. Lescure, “Asymptomatic Neurocognitive Disorders Inpatients Infected by HIV: Fact or Fiction?” BMC Medicine, Vol. 9, 2011, pp. 138-142. doi:10.1186/1741-7015-9-138
[13]	M. Nelson, H. J. Stellbrink, D. Podzamczer, D. Banhegyi, B. Gazzard, A. Hill and Y. van Delft, “A Comparison of Neuropsychiatric Adverse Events during 12 Weeks of Treatment with Etravirine and Efavirenz in a Treatment-Naive, HIV-1-Infected Population,” AIDS, Vol. 25, No. 3, 2011, pp. 335-340. doi:10.1097/QAD.0b013e3283416873