The effects of antiretroviral treatment initiation on cognition in HIV-infected individuals with advanced disease in Pune, India

Abstract

There has been a reduction in the most severe cases of HIV-associated neurocognitive disorders (HAND) with advances in antiretroviral treatment (ART). But the prevalence of milder forms of HAND still remains high. Data from systematically conducted studies on the effects of ART on cognition are scanty in India where HIV-1 clade C is prevalent. The purpose of the present study was to assess the effect of antiretroviral therapy in HIV seropositive (HIV+) individuals (n = 92) with CD4 cell counts < 200 cells/mm3. Overall and domain-specific levels of cognitive functioning were determined using a locally-recruited normative sample and change in neurocognitive functioning at the one-year follow-up visit was analyzed. Results revealed cognitive impairment in 44.6% of the HIV+ group at baseline. At the one-year follow-up, the group showed significant improvement in the Learning domain (p<0.05). HIV+ individuals showing improvement in the global cognitive scores had a significantly lower baseline CD4 cell count compared to others. Overall, the degree of improvement associated with the magnitude of rise in CD4 suggests the possibility that early, mild subclinical declines may also benefit from treatment.

Neurocognitive functioning among HIV-positive adults in southern India

“…The proportion of individuals speaking Telegu in the HIV+ group was significantly lower compared to the HIV− group, warranting cautious interpretation of the group differences in cognitive functioning. Other studies in different geographically/linguistically distinct regions of India have reported mild to moderate cognitive deficits in individuals with HIV-1 Clade C infection 11,12,24 . Our findings are consistent with prior reports of HIV-associated cognitive impairments in Clade C infected cohorts.…”

“…Our findings are consistent with prior reports of HIV-associated cognitive impairments in Clade C infected cohorts. Of note, these studies in Karnataka 12 , Chandigarh 24 , and Pune 11 , as well as our study in Chennai, vary in their study design (e.g., presence or absence of control group), HIV disease characteristics, and assessment approach (e.g., batteries and individual tests used, language of administration). Thus, direct comparisons across studies are not possible; however, there is evidence for a general trend of HIV-associated neurocognitive disorders in diverse Indian cohorts.…”

“…This neuropsychological battery has been translated and adapted for use in three other non-US studies in India 11 , China 10 and Zambia 18 . The prevalence of NCI in HIV-infected patients in this study (33%) is similar to the findings of four other studies (33–45%) shown in Table 3.…”

“…We used the HNRP International NP battery, which has estimated prevalence of HAND in studies in Brazil 9 , Cameroon 8 , China 10 , India 11,12 , Nigeria 13 , South Africa, USA 14 , and Zambia 15 . Nurses were trained and certified to administer the battery.…”

Macrophages in Progressive Human Immunodeficiency Virus/Simian Immunodeficiency Virus Infections

“…These milder neurological disorders have been collectively designated HIV-associated neurocognitive disorder (HAND). Though the frequency of HAD has significantly decreased with HAART, approximately half of all HIV-infected individuals develop some form of HAND (34,55,56). One plausible explanation for HAND is decreased, but incompletely suppressed, viral replication within the central nervous system (CNS) (54,57).…”