Persistence of Neuropsychologic Deficits Despite Long-Term Highly Active Antiretroviral Therapy in Patients With HIV-Related Neurocognitive Impairment

Tozzi, Valerio; Balestra, Pietro; Bellagamba, Rita; Corpolongo, Angela; Salvatori, Maria Flora; Visco-Comandini, Ubaldo; Vlassi, Chrysoula; Giulianelli, Marinella; Galgani, Simonetta; Antinori, Andrea; Narciso, Pasquale

doi:10.1097/qai.0b013e318042e1ee

Cited by 299 publications

(226 citation statements)

References 25 publications

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“…Furthermore, the current CD4 count at diagnosis had no impact on the performance of the NCD test we used. This finding has been reported in Botswana [15] and corroborates the facts reported that the CD4 count as well as other biomarkers such as plasma viral load and the cerebrospinal fluid are not correlated or are not predictive of neurocognitive disorders [46]. The finding that the current CD4 count is not associated with the performance on IHDS was predictable since most subjects received HAART.…”

Section: The Cd4 Count At Treatment Initiationsupporting

confidence: 80%

Determinants of Neurocognitive Impairment in HIV in a Cohort of Patients on Antiretroviral Therapy Followed in Bangui (Central African Republic)

M’Belesso¹,

Tekpa²,

Philomène³

et al. 2016

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Infection with HIV is one of the deadliest epidemics of our time and its type is widespread in the Central African Republic. It is frequently accompanied by neurological complications. Objective: To contribute to a better understanding of neurocognitive disorders in patients living with HIV (PLHIV) in Bangui, and to identify associated factors using the International HIV Dementia Scale (IHDS) as a screening tool. We conducted a descriptive and analytical crosssectional study from 1 December 2014 to 30 January 2015, in a cohort of patients seen on one of the supported sites in Bangui. A total of 400 patients were received in followup visit during the study period of which 244 met the inclusion criteria. The prevalence of neurocognitive disorders was 25%, 95% CI [19.70 30.92]. The mean age of subjects was 42.77 ± 9.58 with extremes ranging from 24 64 years. The sex ratio (F/M) was 4.5 in. The average score for different tests was 10.93 ± 1.13 with extremes of 7 and 12. The disorder was more about the gestural sequence. Determinants of neu rocognitive disorders in the cohort were older age and lower educational level (p < 0.05). It is useful to conduct further studies to confirm these results by combining a battery of neuropsycho logical tests to recommend this test for all the support sites of PLHIV in the country.

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Section: The Cd4 Count At Treatment Initiationsupporting

confidence: 80%

Determinants of Neurocognitive Impairment in HIV in a Cohort of Patients on Antiretroviral Therapy Followed in Bangui (Central African Republic)

M’Belesso¹,

Tekpa²,

Philomène³

et al. 2016

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“…9,10 With the advent of highly-active antiretroviral therapy (HAART) in the mid-to-late ’90s, 11 the neurocognitive sequelae of HIV have lessened in severity 12–14 and become somewhat more variable in expression, 15 although mild neurocognitive deficits persist. 13,16–19 Although the current cognitive impairment-profile of HIV is relatively mild for many individuals, it is nonetheless predictive of significant decline in daily functioning. 20 Also, significant variability in HAART adherence patterns among HIV+ individuals 21 may account for recent reports of variable neurocognitive expression of HIV.…”

mentioning

confidence: 99%

Antiretroviral Adherence and the Nature of HIV-Associated Verbal Memory Impairment

Wright¹,

Woo²,

Foley³

et al. 2011

Journal of Neuropsychiatry

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The authors investigated the relationship between antiretroviral adherence and HIV-associated verbal memory impairment. HIV-positive participants demonstrated poorer verbal memory than HIV-negative participants. Both good (≥90%) and poor (<90%) adherers displayed encoding deficits as compared with controls, but only poor adherers exhibited retrieval deficits. Encoding deficits primarily accounted for reduced delayed recall in good adherers, but both encoding and retrieval deficits accounted for reduced delayed recall in poor adherers. The retrieval difference between the adherence groups might be explained by a neuroprotective effect of good antiretroviral adherence or preexisting HIV-related retrieval deficits that result in poorer adherence.

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“…23 Whereas a study from Canada noted 80% male patients. 24 In our study, also males dominate the sample (60.9%) males. People in certain profession have been found to be more susceptible to contract HIV.…”

Section: Discussionmentioning

confidence: 89%

HIV associated neurocognitive dysfunction and its association with CD4 count in HIV positive patients-a hospital based study

Balaini

Sharma

et al. 2017

Int J Res Med Sci

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Background: The main objective of the present work was to study the neurocognitive dysfunction in HIV positive patients and to determine its relation with CD4 count. Further, an attempt has also been made to study the relationship of neurocognitive dysfunction with cART regimen.Methods: The study was a prospective observational study, conducted over a period of one year (from July 2012 to June 2013) in the Department of Medicine in collaboration with the Department of Psychiatry at Indira Gandhi Medical College and Hospital, Shimla.Results: HIV associated neurocognitive dysfunction (HAND) was found in 39.04% patients. Mean duration from diagnosis of HIV to detection of HAND was 3.77 ± 1.7 years. Mean nadir CD4 cell count was 126.1/mm3. 39.04% patients (n=41) were found to have HIV associated neurocognitive disorder out of 105 screened patients. 95.1% patients (n=39) had asymptomatic neurocognitive impairement, 4.9% patients (n=2) had mild cognitive impairment and 2.08% patients (n=1) had HIV associated dementia. Out of 41 patients having HIV associated neurocognitive disorder, 68.3% patients (n=28) were having CD4 count less than 150. Those having CD4 count less than 150/mm3 had scored less on dementia scales indicating severe disease. 31.7% patients (n=13) were having HIV associated neurocognitive disorder (HAND) and CD4 count was more than 150/mm3.Conclusions: The conclusion of the study is that HIV associated neurocognitive disorder is common and asymptomatic neurocognitive impairement is the commonest type of HIV associated neurocognitive disorder in HIV positive patients. It can be detected while patient is asymptomatic with help of simple neurocognitive tests. Although few studies reported higher prevalence of HIV associated neurocognitive disorder among patients on certain combined antiretroviral therapy (cART) regimen but our study didn’t indicate any such association.

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Persistence of Neuropsychologic Deficits Despite Long-Term Highly Active Antiretroviral Therapy in Patients With HIV-Related Neurocognitive Impairment

Abstract: The severity of NCI at HAART initiation seems to be the strongest predictor of persistent NP deficits despite long-term HAART. Our data indicate that HAART should be initiated as soon as NCI is diagnosed to avoid potentially irreversible neurologic damage.

Cited by 299 publications

References 25 publications

Determinants of Neurocognitive Impairment in HIV in a Cohort of Patients on Antiretroviral Therapy Followed in Bangui (Central African Republic)

Determinants of Neurocognitive Impairment in HIV in a Cohort of Patients on Antiretroviral Therapy Followed in Bangui (Central African Republic)

Antiretroviral Adherence and the Nature of HIV-Associated Verbal Memory Impairment

HIV associated neurocognitive dysfunction and its association with CD4 count in HIV positive patients-a hospital based study

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