Document Detail


The prevalence and incidence of neurocognitive impairment in the HAART era.
MedLine Citation:
PMID:  17721099     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: HAART suppresses HIV viral replication and restores immune function. The effects of HAART on neurological disease are less well understood. The aim of this study was to assess the prevalence and incidence of neurocognitive impairment in individuals who initiated HAART as part of an AIDS clinical trial. DESIGN: A prospective cohort study of HIV-positive patients enrolled in randomized antiretroviral trials, the AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trials (ALLRT) study. METHODS: We examined the association between baseline and demographic characteristics and neurocognitive impairment among 1160 subjects enrolled in the ALLRT study. RESULTS: A history of immunosuppression (nadir CD4 cell count < 200 cells/microl) was associated with an increase in prevalent neurocognitive impairment. There were no significant virological and immunological predictors of incident neurocognitive impairment. Current immune status (low CD4 cell count) was associated with sustained prevalent impairment. CONCLUSION: The association of previous advanced immunosuppression with prevalent and sustained impairment suggests that there is a non-reversible component of neural injury that tracks with a history of disease progression. The association of sustained impairment with worse current immune status (low CD4 cell count) suggests that restoring immunocompetence increases the likelihood of neurocognitive recovery. Finally, the lack of association between incident neurocognitive impairment and virological and immunological indicators implies that neural injury continues in some patients regardless of the success of antiretroviral therapy on these laboratory measures.
Authors:
Kevin R Robertson; Marlene Smurzynski; Thomas D Parsons; Kunling Wu; Ronald J Bosch; Julia Wu; Justin C McArthur; Ann C Collier; Scott R Evans; Ron J Ellis
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  AIDS (London, England)     Volume:  21     ISSN:  0269-9370     ISO Abbreviation:  AIDS     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-27     Completed Date:  2007-11-08     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  1915-21     Citation Subset:  IM; X    
Affiliation:
Department of Neurology, UNC, Chapel Hill, North Carolina 27599, USA. kevinr@neurology.unc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Antiretroviral Therapy, Highly Active / methods*
CD4 Lymphocyte Count
Cognition Disorders / complications,  epidemiology*,  virology
Female
HIV Infections / complications,  drug therapy*,  virology
Humans
Incidence
Male
Middle Aged
Prevalence
Prospective Studies
RNA, Viral / analysis
Grant Support
ID/Acronym/Agency:
AI038858/AI/NIAID NIH HHS; AI068634/AI/NIAID NIH HHS; AI25868-15/AI/NIAID NIH HHS; AI27664/AI/NIAID NIH HHS; MH067751/MH/NIMH NIH HHS; MH5199/MH/NIMH NIH HHS; MH58076/MH/NIMH NIH HHS; MH632690/MH/NIMH NIH HHS; NS049465/NS/NINDS NIH HHS; U01 AI038855/AI/NIAID NIH HHS; U01 NS0322228/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/RNA, Viral

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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