Cognitive dysfunction in HIV patients despite long-standing suppression of viremia

• Published in: AIDS (London) Vol. 24; no. 9; pp. 1243 - 1250
• Main Authors: SIMIONI, Samanta, CAVASSINI, Matthias, DU PASQUIER, Renaud A, ANNONI, Jean-Marie, RIMBAULT ABRAHAM, Aline, BOURQUIN, Isabelle, SCHIFFER, Véronique, CALMY, Alexandra, CHAVE, Jean-Philippe, GIACOBINI, Ezio, HIRSCHEL, Bernard
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.06.2010
• Subjects: Adult; Aged; AIDS/HIV; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Biological and medical sciences; Cognition Disorders - epidemiology; Cognition Disorders - etiology; Female; France - epidemiology; HIV Infections - epidemiology; HIV Infections - psychology; HIV-1 - genetics; Human immunodeficiency virus 1; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Male; Medical sciences; Middle Aged; Neuropsychological Tests; Pharmacology. Drug treatments; Prevalence; RNA, Viral - blood; Surveys and Questionnaires; Switzerland - epidemiology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viremia - prevention & control; France; Switzerland; Immunopathology; Cognitive disorder; Viremia; Retroviridae; AIDS; Cognition; Immune deficiency; Lentivirus; Infection; Virus; Chemotherapy; Microbiological investigation; Treatment; HIV; Viral disease; Antiviral; Human immunodeficiency virus; neuropsychological tests; Viral load; HAART
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0b013e3283354a7b

To determine the prevalence of cognitive complaints and HIV-associated neurocognitive disorders (HANDs) in a cohort of aviremic HIV-positive patients. To evaluate the relevance of the HIV dementia scale to detect HANDs. Assessment of HANDs with neuropsychological tests. Two hundred HIV-infected patients with undetectable HIV-1 RNA concentrations in the plasma, no history of major opportunistic infection of the central nervous system in the past 3 years, no current use of intravenous drugs, and no major depression answered a questionnaire designed to elicit cognitive complaints. Cognitive functions of 50 complaining and 50 noncomplaining HIV-positive patients were assessed. Patients had undetectable HIV-1 RNA concentrations for a median time of 48 months (range 3.2-136.6). The prevalence of cognitive complaints was 27%. The prevalence of HANDs was 84% among patients with cognitive complaints (asymptomatic neurocognitive impairment 24%, mild neurocognitive disorders 52%, and HIV-associated dementia 8%) and 64% among noncomplainers (asymptomatic neurocognitive impairment 60%, mild neurocognitive disorders 4%, and HIV-associated dementia 0%; P < 0.001). A score of 14 points or less on the HIV dementia scale yielded a positive predictive value of HANDs of 92% in complainers and 82% in noncomplainers. The prevalence of HANDs is high even in long-standing aviremic HIV-positive patients. However, HANDs without functional repercussion in daily life (asymptomatic neurocognitive impairment) is the most frequent subtype observed. In this population, the HIV dementia scale with a cutoff of 14 points or less seems to provide a useful tool to screen for the presence of HANDs.