HIV Suppression
with HAART Preserves Cognitive Function in Patients with AIDS
Although
AIDS-associated dementia is not as prominent an issue as it was in the early years
of the epidemic, HIV-related cognitive impairment remains a concern in the HAART
era. In the May 31, 2007 issue of AIDS, researchers reported on a study
of cognitive function in patients with AIDS who respond well to combination antiretroviral
therapy.
As background, the authors noted that HIV can damage neurons,
thereby impairing cognitive function. Some epidemiological observations suggest
that neuropsychological impairment might progress
despite successful HAART, but this is not yet fully understood.
The present
study included 433 advanced AIDS patients with no confounding neurological conditions;
all subjects had experienced documented immune reconstitution, defined as CD4
cell counts previously below 50 but rising to more than 100 cells/mm3 after starting
HAART. At baseline, the median CD4 cell count was 230 cells/mm3 and 65% had viral
loads below 500 cells/mL (only 14% still had more than 20,000 copies/mL). Of this
group, 286 received brief assessments of cognition (Trailmaking A/B and Digit
Symbol tests) at least once.
Results
•
More than
one-quarter of participants (27%) exhibited impairment at their initial neuropsychological
assessment.
•
This
rate was nearly twice the 14% rate expected in a normal HIV negative reference
population.
•
Impaired
study participants did not differ from the unimpaired group with respect to age,
sex, education, race, CD4 cell count, or viral load.
•
Improved
performance on neuropsychological tests was documented over a 2-year period, 3-5
years after starting HAART.
•
This
improvement was marginally associated with continued or improving control of plasma
HIV RNA, but not with concurrent immune recovery as indicated by CD4 counts.
Conclusion
"Most
advanced AIDS patients responding to HAART for prolonged periods have stable or
improving cognition, but remain more likely to be impaired than the general population,"
the authors concluded. "During HAART, improving test performance probably
reflects both practice effects and continuing neurological recovery after more
than 3 years of HAART."
University of California, San Diego, CA;
Harvard School of Public Health, Boston, MA; University of North Carolina, Chapel
Hill, NC; Ohio State University, Columbus, OH; University of Rochester School
of Medicine, Rochester, NY; University of California, Los Angeles, CA.
06/19/07
Reference JA
McCutchan, JW Wu, K Robertson, and others. HIV suppression by HAART preserves
cognitive function in advanced, immune-reconstituted AIDS patients. AIDS
21(9): 1109-1117. May 31, 2007.
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