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Dementia, one of the most feared complications of HIV infection, has been declining in incidence since the introduction of effective antiretroviral therapy (ART). However, milder degrees of neurocognitive impairment continue to be seen in HIV-infected patients. To assess the situation, investigators examined the prevalence and incidence of neurocognitive impairment in 1160 ACTG clinical trial participants (347 African American, 813 Caucasian).
Using a battery of neurocognitive screening tests, the investigators found that 26% of the participants had mild-to-moderate impairment at their first visit. Of those with mild impairment at baseline who had follow-up testing, 44% improved with ART. Sustained mild neurocognitive impairment was associated with low baseline and nadir CD4-cell counts. Virologic response and baseline HIV-RNA level were not significantly associated with baseline impairment. Twenty-one percent of the participants who were neurologically normal at the outset developed impairment during the course of the study.
Robertson KR et al. The prevalence and incidence of neurocognitive impairment in the HAART era. AIDS 2007 Sep; 21:1915.
Comment
This study highlights the relatively high rate of baseline neurocognitive impairment in HIV-infected patients and shows that ART is not always effective at reversing or preventing neurologic decline. The finding that advanced immunosuppression is associated with persistent neurologic dysfunction supports the case for more-widespread testing for HIV infection so that patients can be diagnosed and treated earlier in the course of disease. The researchers did not assess whether different antiretroviral regimens affect neurologic outcome; this issue and other treatment strategies should be evaluated in prospective clinical trials.