Prevalence and risk factors for human immunodeficiency virus–associated neurocognitive impairment, 1996 to 2002: Results from an urban observational cohort

Abstract

To assess prevalence and risk factors for human immunodeficiency virus (HIV)-related neurocognitive impairment (NCI), the authors performed a 7-year survey in the period 1996 to 2002. A total of 432 patients were examined. HIV-related NCI was diagnosed in 238 patients (55.1%), meeting the HIV dementia (HIV-D) criteria in 45 (10.4%). The prevalence of both NCI and HIV-D did not change significantly during the study period. Compared with patients without NCI, patients with NCI were older (40.4 versus 38.2 years; P = .003), had a higher prevalence of positive HCV serology (61.1% versus 38.9%; P = .003), and a lower nadir CD4 cell count (156 versus 222 cells/microl; P < .001). Compared with patients seen during 1996 to 1999, patients with NCI seen during 2000 to 2002 were older (40.7 versus 38.8 years; P = .004), had a less advanced disease stage (previous acquired immunodeficiency syndrome [AIDS] 28.8% versus 65.7%; P < .001) and a higher nadir CD4 count (174 versus 132 cells/microl; P = .026). This study showed an unchanged prevalence of both HIV-related NCI and HIV-D in the period 1996 to 2002. The authors found evidences for new additional potential risk factors for HIV-related NCI (older age, lower nadir CD4 count, positive hepatitis C virus [HCV] serology), and for a change of risk factors for NCI in the late highly active antiretroviral therapy (HAART) era (older age, less advanced disease, higher nadir CD4 count).

Metabolomic analysis of the cerebrospinal fluid reveals changes in phospholipase expression in the CNS of SIV-infected macaques

“…In many countries, highly active antiretroviral therapy (HAART) has been successfully implemented, leading to greatly decreased mortality and prolonged course of infection. However even in the current era of treatment, the brain remains a target for damage and dysfunction: in spite of HAART lowering the overall incidence of CNS problems, the prevalence of infected individuals with CNS neurocognitive disorders has remained the same or possibly increased (2)(3)(4)(5). This may be due in part to the fact that many HIV therapeutics do not cross the blood-brain barrier in sufficient quantity (6), as well as the now-prolonged course of infection.…”

Neurologic disease burden in treated HIV/AIDS predicts survival

“…These factors might contribute to the lower prevalences of DSP and HAND compared with other recruited cohorts or studies conducted in neurology clinics. 8,9,11,23 Unlike DSP and HAND, the prevalence and incidence of several neurologic disorders herein remain unchanged in the cART era. The incidence of mononeuropathy was consistent during the study period, likely because immunologic and virologic variables were less robust risk factors for this disorder.…”

“…The differences in the prevalence of neurocognitive impairment in HIV-infected individuals in different studies lie in the population selection and study design. Tozzi et al 8 reported a 55.1% prevalence of HIV-related neurocognitive impairment in 432 patients undergoing their first neuropsychological tests in an institute which provides care to more than 3,500 HIV-infected individuals. A recent study of HAND prevalence in HIV-infected individuals with suppressed viremia by Simioni et al 23 using questionnaire and neuropsychological tests estimated the prevalence of HAND at 69%; however, the majority of patients with HAND had asymptomatic neurocognitive impairment.…”

“…Studies from North America and Europe of HIV-infected patients receiving cART report improved outcomes of major neurologic disorders including HIV-associated dementia (HAD), [3][4][5][6] distal sensory polyneuropathy (DSP), 7 and CNS opportunistic infections (CNS-OI), 3,6 while other studies showed no change in prevalence of HAD during the early cART period. 8 The prevalence of DSP appears higher in the cART era, possibly caused by exposure to neurotoxic antiretroviral therapies. 9,10 Unlike these well-recognized complications, the incidence and prevalence of other neurologic disorders, e.g., seizure, headache, and myopathy, have not been prospectively documented in treated HIV infection.…”

Cognitive function in treated HIV patients

“…Risk factors for HAND include current or past low CD4 cell count, 6,[15][16][17][18] advanced age, 15,16,19 coinfection with hepatitis C virus, 18,20 insulin resistance or diabetes, 19 and cardiovascular risk factors. 21 Advanced immune suppression, either current or historical, and older age are strong risk factors for HAND, being reported in most published studies.…”