Although far fewer individuals with HIV
suffer from AIDS-related
dementia compared with the early years of the epidemic, neurocognitive impairment
remains a concern. While HAART can sometimes reverse HIV-related neurocognitive
impairment, neuropsychological deficits may persist in a substantial proportion
of patients despite antiretroviral treatment.
Autoimmune
Overload May Damage HIV-Infected Brain White
blood cells may be cause of dementia in people with AIDS
As
reported in the June 1, 2007 issue of AIDS, Italian researchers assessed
the prevalence and predictors of persistent neuropsychological deficits despite
long-term HAART in 94 patients
with HIV-related neurocognitive impairment. Study participants underwent 2-7 series
of neuropsychological tests, neurological examination, and brain imaging studies.
Patients were followed on HAART for a mean of 63 months (range 6-127).
According
to neuropsychological assessment results, subjects were considered to have reversible
or persistent neuropsychological deficits. Kaplan-Meier analyses and Cox proportional
hazards models were used to analyze time to first evidence of reversal of neuropsychological
deficits.
Results
• During the follow-up period,
persistent neuropsychological deficits were observed in 59 patients (62.8%).
• 37.2% of patients had reversible
neuropsychological deficits.
•
Persistent neuropsychological deficits were not associated with age,
sex, CDC disease stage, HIV risk category, baseline CD4 cell count or plasma viral
load, use of central nervous system-penetrating drugs, response to HAART, or changes
in CD4 count or viral load.
•
Patients with persistent neuropsychological deficits were less educated
and showed poorer baseline performance on neuropsychological measures assessing
concentration, mental processing speed, memory, and mental flexibility.
• Patients with persistent
deficits were also more likely to be coinfected with hepatitis C virus (HCV).
• In multivariable analyses,
only the baseline severity of neurocognitive impairment, as measured by the composite
NPZ8 global score, remained significantly associated with persistent neuropsychological
deficits (odds ratio 3.07; P = 0.001).
Conclusion
"The
severity of neurocognitive impairment at HAART initiation seems to be the strongest
predictor of persistent neuropsychological deficits despite long-term HAART,"
the investigators concluded. "Our data indicate that HAART should be initiated
as soon as neurocognitive impairment is diagnosed to avoid potentially irreversible
neurologic damage."
"Our research indicates that the subgroup
of patients with the hardest to treat neurocognitive impairment condition is the
one with the most severe neurocognitive impairment at HAART initiation,"
lead author Valerio Tozzi told Reuters Health. "HAART improves neurocognitive
functioning but, in our experience, the greater is the impairment, the lower is
the probability of its full reversal."
07/06/07
Sources
V
Tozzi, P Balestra, R Bellagamba, and others. Persistence of neuropsychologic deficits
despite long-term highly active antiretroviral therapy in patients with HIV-related
neurocognitive impairment: prevalence and risk factors. JAIDS 45(2): 174-182.
June 1, 2007.
W Boggs. HIV-Related Neuropsychological Deficits Persist
Despite Treatment. Reuters Health. June 26, 2007.
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