Neurocognitive change in the era of HIV combination antiretroviral therapy: the longitudinal CHARTER study.

TitleNeurocognitive change in the era of HIV combination antiretroviral therapy: the longitudinal CHARTER study.
Publication TypeJournal Article
Year of Publication2015
AuthorsHeaton, RK, Franklin, DR, Deutsch, R, Letendre, S, Ellis, RJ, Casaletto, K, Marquine, MJ, Woods, SP, Vaida, F, J Atkinson, H, Marcotte, TD, J McCutchan, A, Collier, AC, Marra, CM, Clifford, DB, Gelman, BB, Sacktor, N, Morgello, S, Simpson, DM, Abramson, I, Gamst, AC, Fennema-Notestine, C, Smith, DM, Grant, I
Corporate AuthorsCHARTER Group
JournalClin Infect Dis
Volume60
Issue3
Pagination473-80
Date Published2015 Feb 1
ISSN1537-6591
KeywordsAdult, Cognition Disorders, Comorbidity, Female, HIV Infections, Humans, Longitudinal Studies, Male, Middle Aged
Abstract

BACKGROUND: Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) can show variable clinical trajectories. Previous longitudinal studies of HAND typically have been brief, did not use adequate normative standards, or were conducted in the context of a clinical trial, thereby limiting our understanding of incident neurocognitive (NC) decline and recovery.

METHODS: We investigated the incidence and predictors of NC change over 16-72 (mean, 35) months in 436 HIV-infected participants in the CNS HIV Anti-Retroviral Therapy Effects Research cohort. Comprehensive laboratory, neuromedical, and NC assessments were obtained every 6 months. Published, regression-based norms for NC change were used to generate overall change status (decline vs stable vs improved) at each study visit. Survival analysis was used to examine the predictors of time to NC change.

RESULTS: Ninety-nine participants (22.7%) declined, 265 (60.8%) remained stable, and 72 (16.5%) improved. In multivariable analyses, predictors of NC improvements or declines included time-dependent treatment status and indicators of disease severity (current hematocrit, albumin, total protein, aspartate aminotransferase), and baseline demographics and estimated premorbid intelligence quotient, non-HIV-related comorbidities, current depressive symptoms, and lifetime psychiatric diagnoses (overall model P < .0001).

CONCLUSIONS: NC change is common in HIV infection and appears to be driven by a complex set of risk factors involving HIV disease, its treatment, and comorbid conditions.

DOI10.1093/cid/ciu862
Alternate JournalClin. Infect. Dis.
PubMed ID25362201
PubMed Central IDPMC4303775
Grant ListDP1 DA034978 / DA / NIDA NIH HHS / United States
K24 AI100665 / AI / NIAID NIH HHS / United States
N01 MH22005 / MH / NIMH NIH HHS / United States
P30 AI036214 / AI / NIAID NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
R01 MH083552 / MH / NIMH NIH HHS / United States
R01 MH097520 / MH / NIMH NIH HHS / United States