The prevalence and incidence of neurocognitive impairment in the HAART era.

TitleThe prevalence and incidence of neurocognitive impairment in the HAART era.
Publication TypeJournal Article
Year of Publication2007
AuthorsRobertson KR, Smurzynski M, Parsons TD, Wu K, Bosch RJ, Wu J, McArthur JC, Collier AC, Evans SR, Ellis RJ
JournalAIDS
Volume21
Issue14
Pagination1915-21
Date Published2007 Sep 12
ISSN0269-9370
KeywordsAdult, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Cognition Disorders, Female, HIV Infections, Humans, Incidence, Male, Middle Aged, Prevalence, Prospective Studies, RNA, Viral
Abstract

OBJECTIVES: HAART suppresses HIV viral replication and restores immune function. The effects of HAART on neurological disease are less well understood. The aim of this study was to assess the prevalence and incidence of neurocognitive impairment in individuals who initiated HAART as part of an AIDS clinical trial.

DESIGN: A prospective cohort study of HIV-positive patients enrolled in randomized antiretroviral trials, the AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trials (ALLRT) study.

METHODS: We examined the association between baseline and demographic characteristics and neurocognitive impairment among 1160 subjects enrolled in the ALLRT study.

RESULTS: A history of immunosuppression (nadir CD4 cell count < 200 cells/microl) was associated with an increase in prevalent neurocognitive impairment. There were no significant virological and immunological predictors of incident neurocognitive impairment. Current immune status (low CD4 cell count) was associated with sustained prevalent impairment.

CONCLUSION: The association of previous advanced immunosuppression with prevalent and sustained impairment suggests that there is a non-reversible component of neural injury that tracks with a history of disease progression. The association of sustained impairment with worse current immune status (low CD4 cell count) suggests that restoring immunocompetence increases the likelihood of neurocognitive recovery. Finally, the lack of association between incident neurocognitive impairment and virological and immunological indicators implies that neural injury continues in some patients regardless of the success of antiretroviral therapy on these laboratory measures.

DOI10.1097/QAD.0b013e32828e4e27
Alternate JournalAIDS
PubMed ID17721099
Grant ListAI038858 / AI / NIAID NIH HHS / United States
AI068634 / AI / NIAID NIH HHS / United States
AI25868-15 / AI / NIAID NIH HHS / United States
AI27664 / AI / NIAID NIH HHS / United States
MH067751 / MH / NIMH NIH HHS / United States
MH5199 / MH / NIMH NIH HHS / United States
MH58076 / MH / NIMH NIH HHS / United States
MH632690 / MH / NIMH NIH HHS / United States
NS049465 / NS / NINDS NIH HHS / United States
U01 AI038855 / AI / NIAID NIH HHS / United States
U01 NS0322228 / NS / NINDS NIH HHS / United States