Low prevalence of neurocognitive impairment in early diagnosed and managed HIV-infected persons

• Published in: Neurology Vol. 80; no. 4; p. 371
• Main Authors: Crum-Cianflone, Nancy F, Moore, David J, Letendre, Scott, Poehlman Roediger, Mollie, Eberly, Lynn, Weintrob, Amy, Ganesan, Anuradha, Johnson, Erica, Del Rosario, Raechel, Agan, Brian K, Hale, Braden R
• Format: Journal Article
• Language: English
• Published: United States 22.01.2013
• Subjects: Adolescent; Adult; AIDS Dementia Complex - diagnosis; AIDS Dementia Complex - drug therapy; AIDS Dementia Complex - epidemiology; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active - statistics & numerical data; CD4 Lymphocyte Count - statistics & numerical data; Cognition Disorders - diagnosis; Cognition Disorders - epidemiology; Cognition Disorders - virology; Comorbidity; Cross-Sectional Studies; Early Diagnosis; Female; Humans; Male; Middle Aged; Military Personnel - statistics & numerical data; Neuropsychological Tests; Prevalence; Risk Factors; Young Adult
• ISSN: 1526-632X
• DOI: 10.1212/WNL.0b013e31827f0776

To describe the prevalence of neurocognitive impairment (NCI) among early diagnosed and managed HIV-infected persons (HIV+) compared to HIV-negative controls. We performed a cross-sectional study among 200 HIV+ and 50 matched HIV-uninfected (HIV-) military beneficiaries. HIV+ patients were categorized as earlier (<6 years of HIV, no AIDS-defining conditions, and CD4 nadir >200 cells/mm(3)) or later stage patients (n = 100 in each group); both groups were diagnosed early and had access to care. NCI was diagnosed using a comprehensive battery of standardized neuropsychological tests. HIV+ patients had a median age of 36 years, 91% were seroconverters (median window of 1.2 years), had a median duration of HIV of 5 years, had a CD4 nadir of 319, had current CD4 of 546 cells/mm(3), and 64% were on highly active antiretroviral therapy (initiated 1.3 years after diagnosis at a median CD4 of 333 cells/mm(3)). NCI was diagnosed among 38 (19%, 95% confidence interval 14%-25%) HIV+ patients, with a similar prevalence of NCI among earlier and later stage patients (18% vs 20%, p = 0.72). The prevalence of NCI among HIV+ patients was similar to HIV- patients. HIV+ patients diagnosed and managed early during the course of HIV infection had a low prevalence of NCI, comparable to matched HIV-uninfected persons. Early recognition and management of HIV infection may be important in limiting neurocognitive impairment.