Persistence of Neuropsychologic Impairment After Starting ART

HIV-related neurocognitive impairment (NCI — previously termed “AIDS dementia”) is a feared complication of advanced HIV infection. Although potent antiretroviral therapy (ART) can reverse such impairment, it does not always do so completely, and many patients are left with persistent neuropsychologic deficits.

To evaluate the prevalence of such persistent deficits, investigators prospectively followed 94 patients who had evidence of HIV-related NCI at baseline (as determined by a battery of neuropsychologic tests after other conditions had been ruled out). Per enrollment criteria, all patients had symptomatic HIV infection or CD4 counts <200 cells/mm³ (mean nadir CD4 count, 158 cells/mm³; mean baseline CD4 count, 257 cells/mm³). Thirty-two patients were treatment-experienced, and the other 62 initiated ART at enrollment. Initial regimens were PI-based for 51 patients and NNRTI-based for 38. Twenty patients met the criteria for HIV-related dementia at baseline.

During an average follow-up of 63 months, persistent neuropsychologic deficits were noted in 63% of patients. Mean CD4 count at the last follow-up visit was 451 cells/mm³. Age, sex, disease stage, CD4-cell count (baseline or most recent), viral load, and use of CNS-penetrating drugs were not associated with persistent neuropsychologic deficits. In a multivariate analysis, baseline severity of NCI was the only factor significantly associated with persistent neuropsychologic deficits (odds ratio, 3.07).