Neuroactive HAART Helps Neuropsychologically Impaired HIV Patients  

By David Douglas

Although HAART using neuroactive drugs has no direct benefit in patients with advanced HIV infection, it appears to be of some help in those with neuropsychological impairment, Australian researchers report in the November issue of the Archives of Neurology.

Nevertheless, lead researcher Lucette A. J. Cysique told Reuters Health "prospective studies are necessary to see whether the changes that we observed are sustained over the long-term and to understand how the presentation of HIV-related neurocognitive dysfunctions may be affected."

Ms. Cysique of the University of New South Wales, Sydney, and colleagues note that neuropsychological impairment is common in HIV patients. One possible cause is that HAART agents may not reach the central nervous system in effective concentrations.

To investigate whether HAART using neuroactive drugs -- those able to achieve effective CNS concentrations -- might have advantages over standard HAART, the researchers surveyed 97 HIV patients, whose disease had been stable for a median of more than 18 months.

Of these, 41 had regimens containing three or more neuroactive drugs and they were deemed to be receiving neuroactive HAART. The regimens of the remaining 56 did not.

Based on findings in seven cognitive domains such as learning and short-term recall, there were no between-group differences in neuropsychological performance. However, both groups showed impairment when compared with controls.

Moreover, when impaired patients in both groups were compared, those in the neuroactive HAART group showed significantly better memory performance. This was unrelated to viral load and to the number of neuroactive drugs employed.

These findings, say the researchers, suggest "a threshold of neuropsychological impairment is required for the benefit of neuroactive HAART."

Furthermore, Ms. Cysique commented, "neurocognitive screening in patients with HIV infection remains very important."

12/10/04

Arch Neurol 2004;61:1699-1704.

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