This is a common question yet there is not a definitive answer. Different ARVs do penetrate the CNS to different extents. However, it is not completely clear from the data that greater CSF concentrations of HIV meds lead to any benefits in reagard to viral suppression or treatment/prevention of CNS manifestations of HIV.
Many clinicians do chose to use meds that get into the CNS when treating patients with HIV dementia and few can argue with this approach.
According to David Simpson, an HIV neurologist, "Agents shown to have the best CSF penetration include ZDV, stavudine, abacavir, nevirapine, and indinavir. In addition to the absolute drug concentration in the CSF, one must consider how effectively the drug inhibits viral replication. Thus some agents, such as efavirenz, with only little CSF penetration, are likely to reach CSF levels that exceed IC95."
The package insert of most HIV meds also include data on CSF penetration.
DW
