This article is more than 5 years old. Information may no longer be current.
Complex motor disfunction common in patients with longstanding HIV
An analysis of data collected by the National NeuroAIDS Tissue Consortium, or NNTC, showed that complex motor dysfunction remains common among patients with HIV and is associated with cerebrovascular disease, AIDS-related CNS disorders and HIV-associated neurocognitive disorder, researchers reported.
The NNTC is a nationwide longitudinal cohort study composed of “medically complex individuals with longstanding HIV.” Overall, almost 7 in 10 participants showed some abnormality on a scale that measures motor dysfunction in patients with HIV.
“With many patients entering their third and even fourth decades of HIV infection, comorbidities such as cerebrovascular disease (CVD) are increasing, occurring on a background of aging, the inflammatory effects of chronic viral infection, long-term use of [combination ART], and in some cases a prior history of AIDS-related CNS disorders (ARCD),” Jessica Robinson-Papp, MD, MS, associated professor of neurology at the Icahn Medical School at Mount Sinai in New York, and colleagues wrote.
According to the study, NNTC participants regularly undergo neurological examination, neuropsychological testing and immunovirologic data collection. The researchers assessed them using a modified HIV Motor Scale (MHMS), a “validated tool which captures motor abnormalities on routine examination.” They used NNTC data to calculate participants’ MHMS scores, which were then correlated with their history of ARCD, CVD and HIV-associated neurocognitive disorder (HAND).
Robinson-Papp and colleagues specifically included all NNTC participants who had neurologic examinations between August 2017 and March 2019. They reported that 69% of participants demonstrated an abnormality on the MHMS. Of these, 27% were classified as severe.
According to the study, 54% of participants had problems with their gait — the most common abnormality. This was followed by 39% who experienced problems with coordination and 25% with strength. These abnormalities commonly occurred together, the researchers said.
In a univariate analysis, a higher — or worse — HMS score was associated with CVD (P = .02), a history of ARCD (P = .001) and HAND (P = .001). In a multivariate analysis, the CVD and ARCD association persisted, according to the study.
The researchers also noted that CVD was “marginally associated” with symptomatic HAND.
“These findings raise the question of whether motor dysfunction in HIV may be the end result of neurologic multi-morbidity, akin to the systemic multi-morbidity that has become an increasingly recognized feature of cART-era HIV,” Robinson-Papp and colleagues wrote
They recommended future studies to investigate “the longitudinal trajectory of HIV-associated motor dysfunction, its neural substrates and impact on quality of life.”
“Such improved understanding should ultimately lead to targeted interventions to reverse neurologic multi-morbidity and improve motor function in [people living with HIV],” Robinson-Papp and colleagues wrote. – by Marley Ghizzone
Disclosures: Robinson-Papp reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.