Antiretroviral therapy improves cognitive impairment in HIV+ individuals in sub-Saharan Africa.
BACKGROUND
Highly active antiretroviral therapy (HAART) can improve cognitive performance in some patients with HIV-associated cognitive impairment in the United States. The effect of HAART on HIV dementia in sub-Saharan Africa is largely unknown.


OBJECTIVE
To evaluate neuropsychological test and functional performance in HIV+ individuals after 3 and 6 months of HAART in Uganda.


METHODS
Twenty-three HIV+ individuals receiving HAART also received a detailed clinical history, neuropsychological testing, and a functional assessment. Follow-up evaluations were performed at 3 and 6 months after baseline. Longitudinal changes in the HIV dementia stage, the mean Z score for each neuropsychological test, and the Karnofsky Functional Performance Scale were evaluated at 3 and 6 months.


RESULTS
The mean (SD) CD4 cell count improved from 71 (15) at baseline to 161 (30) at 3 months (p = 0.005) and 222 (46) at 6 months (p < 0.001). Improvements were found in the Memorial Sloan Kettering HIV dementia stage and in tests of verbal memory, psychomotor speed, and executive functioning after 3 and 6 months of HAART (p < 0.001 at 6 months for each neuropsychological test). There was also improvement in the Karnofsky Functional Performance Scale at both 3 and 6 months after the initiation of HAART (p < 0.001).


CONCLUSIONS
Highly active antiretroviral therapy (HAART) can be associated with improvement in neurocognitive and functional performance in HIV+ individuals in sub-Saharan Africa. These results suggest that HAART, if available in areas with limited resources in sub-Saharan Africa, should be provided for patients with HIV-associated cognitive impairment.
Sacktor
N
N
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. sacktor@jhmi.edu
Nakasujja
N
N
Skolasky
R
R
Robertson
K
K
Wong
M
M
Musisi
S
S
Ronald
A
A
Katabira
E
E
D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D003072:Cognition Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents