Outcome of patients with HIV-1-related cognitive impairment on highly active antiretroviral therapy.
OBJECTIVE
To examine the impact of highly active antiretroviral therapy (HAART) on the outcome of HIV-1-related cognitive impairments using a neuropsychological (NP) battery to assess separately the psychomotor, executive function and memory fields.


METHODS
A longitudinal study of HIV-1-infected patients based on serial NP tests in a Paris University Hospital.


METHODS
A group of 91 HIV-1-infected patients, of whom 47 were already taking HAART at their first NP examination, were initially categorized as cognitively impaired (n = 53) or non-impaired (n = 38) and underwent one to six serial NP batteries (mean follow-up 12.3+/-8.3 months). Generalized estimating equations (GEE) were used to evaluate performance in a given NP test according to the number of days on HAART.


RESULTS
Despite a 25% mortality rate among patients who had cognitive impairment at their first NP examination, GEE showed a positive relationship between the duration of HAART and cognitive performance. Performance in psychomotor tests (e.g. Purdue Pegboard dominant hand) improved continuously during the study period, while memory test performance (e.g. Grober and Buschke free recall) tended to reach a plateau.


CONCLUSIONS
HAART improves subcortical cognitive functions during the first year of treatment. Distinct neuropathological mechanisms appear to underlie psychomotor and memory dysfunctions in AIDS.
Suarez
S
S
Fédération de Neurologie, INSERM U.360, Groupe hospitalier Pitié-Salpêtrière, Paris, France.
Baril
L
L
Stankoff
B
B
Khellaf
M
M
Dubois
B
B
Lubetzki
C
C
Bricaire
F
F
Hauw
J J
JJ
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D003071:Cognition; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology*; D015497:HIV-1; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D019562:Viral Load