HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy.

Type: Poster
Title: HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy.
Authors: Heaton R, Franklin D, Ellis RJ, Letendre S, LeBlanc S, Woods SP, Clifford D, Rivera-Mindt M, Taylor M, Marcotte T, Atkinson JH, Collier A, Marra CM, Gelman B, McArthur J, Morgello S, Simpson D, McCutchan JA, Grant I, for the CHARTER and HNRC Groups
Date: 02-02-2011
Abstract:Background: CART has greatly reduced medical mordbidity and mortality in HIV, but there is evidence that neurological complications remain common Lack of large scale, neurological studies with comparable methodologies for pre-CART versus CART make accurate estimates of the prevalence of HAND in the pre-CART and CART eras difficult DESIGN 857 individuals (HIV-, n=179; non-AIDS, n=516; AIDS, n=162) from the pre-CART era (1990-1995) were compared to 937 individuals (HIV-, n=94; non-AIDS, n=336; AIDS, n=506) from the CART era (2000-2007) on the basis of having received comparable comprehensive neuromedical and neuropsychological (NP) evaluations SUBJECTS Inclusion: HIV-uninfected; HIV-infected and on/off ART Exclusion: Comorbid conditions that may cause neuropsychological impairment independent of HIV ASSESSMENTS Comprehensive, standardized NP assessment of 7 cognitive domains NP test scores are all corrected for relevant demographic characteristics (age, education, gender and Caucasian vs African-American ethnicity, as appropriate); consistent with international criteria for diagnosing HAND, “NP Impairment” required presence of at least mild impairment of ≥ 2 ability domains Neuromediccal examinations according to a standardized protocol Conclusions: NCI remains prevalent despite CART. Asymptomatic, non-AIDS (CDC class A) patients have more HAND in the CART era than in the pre-CART era. Longer survival on CART may allow continued brain damage from undetected HIV replication, chronic inflammation or immune-mediated degeneration in the CNS. Reasons for observed HAND pattern differences in pre-CART vs CART era are currently unknown, but would be consistent with some shift to relatively greater cortical involvement. Neuroimaging and neuropathology studies should explore this possibility.