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HIV, ART, comorbidities linked to neurocognitive changes
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Neurocognitive changes were common among people with HIV and seemed to be driven by the disease, its treatment and comorbid conditions, according to new data.
“We found that almost 40% of subjects showed neurocognitive change, with 23% declining and 17% improving,” the researchers wrote in Clinical Infectious Diseases. “The clinical significance of decliner status, in particular, is supported by significantly higher rates of symptomatic neurocognitive impairment in this group compared to those who were stable or improved.”
Robert K. Heaton, PhD, of the University of California, San Diego, and colleagues conducted a longitudinal study to evaluate neurocognitive changes and predictors among 436 patients with HIV enrolled in the CHARTER study. All participants underwent venipuncture, neuromedical assessment, comprehensive neurocognitive testing and provided detailed history on substance use and psychiatric conditions. Consenting participants also underwent lumbar puncture. The researchers used recently published, regression-based norms to determine neurocognitive change.
During the follow-up period, 22.7% of participants experienced neurocognitive decline and 16.5% of participants demonstrated neurocognitive improvement. The remaining 60.8% of participants were classified as stable. Among the decliners, 66.7% met criteria for symptomatic neurocognitive impairment during follow up vs. 37.5% of the improvers and 40.4% of those who were stable.
In multivariate analysis, predictors of earlier time to neurocognitive decline included Hispanic ethnicity, confounded comorbidity status, being off ART, low albumin, low hematocrit, more depressive symptoms and a diagnosis of lifetime methamphetamine. Predictors of neurocognitive improvement included higher pre-morbid IQ estimate, lower total protein, lower aspartate aminotransferase (AST) and no lifetime major depressive disorder.
“As an observational study, CHARTER is unable to demonstrate ART effects,” the researchers wrote. “Nevertheless, beneficial effects of combination ART on viral load and immune function are well established, so the joint, time-dependent links of ART status and associated HIV biomarkers with both positive and negative neurocognitive outcomes are potentially important.”
Disclosure: See study for a full list of relevant financial disclosures.
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