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Durable Virological Suppression Improves Survival in Neurocognitively
Impaired Patients on HAART
Before
the introduction of HAART, HIV-associated neurocognitive impairment
(NCI) was recognized as an independent risk factor
for death.
Since 1996, researchers have conducted a prospective study to assess
whether NCI still represents a negative prognostic factor for mortality.
Patients
were administered measures of neurocognitive
function (a battery of 17 neuropsychological tests),
clinical and neurological evaluation, laboratory testing, and brain
imaging studies.
Results
· Among
the 412 enrolled patients, 224 (54.4%) were neurocognitively impaired
and 188 (45.6%) were neurocognitively unimpaired.
· A
durable virological suppression from use of HAART was achieved by
63.3% of unimpaired patients and by 49.6% of impaired patients (p
= 0.007).
· Overall,
47 deaths were recorded, 38 among impaired and 9 among unimpaired
patients.
· At
84 months, the estimated survival proportions in impaired and unimpaired
patients were 68.5% and 84.9%, respectively (p < 0.001).
· At
univariate analysis the virological response to HAART was the variable
most strongly associated with survival, since
patients with virological failure
had a nearly 10-fold increased risk of death than those with durable
virological suppression.
·
After
stratification for virological response to HAART, an increased risk
of death for neurocognitively impaired patients was seen only among
the 182 patients with virological failure, while the survival probability
of the 230 patients with durable virological suppression was not
affected by neurocognitive impairment (p = 0.89).
Based
on these findings, the authors conclude, “Our results highlight
the clinical relevance of HIV-related central nervous system (CNS) involvement
in the HAART era, and raise concerns regarding the clinical relevance
of CNS involvement as potent antiretroviral therapies become less
effective.”
09-28-05
Reference
V Tozzi
and others. Neurocognitive Impairment and Survival in a Cohort of
HIV-Infected Patients Treated with HAART. AIDS Research and Human
Retroviruses 21(8): 706-713. August 2005.
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