title: Persistence of neuropsychologic deficits despite long-term highly active antiretroviral therapy in patients with HIV-related neurocognitive impairment: prevalence and risk factors.
abstract: OBJECTIVE
  Although highly active antiretroviral therapy (HAART) can reverse HIV-related neurocognitive impairment (NCI), neuropsychologic (NP) deficits may persist in a substantial proportion of patients despite antiretroviral treatment. We assessed the prevalence and predictors of persistent NP deficits despite long-term HAART in patients with HIV-related NCI.
  
  
  METHODS
  A group of 94 patients with HIV-related NCI underwent 2 to 7 serial NP batteries, neurologic examination, and brain imaging studies. Patients received HAART for a mean of 63 (range: 6-127) months. According to NP assessment results, patients were considered to have reversible or persistent NP deficits. Kaplan-Meier analyses and Cox proportional hazards models were used to analyze time to first evidence of NP deficit reversion.
  
  
  RESULTS
  Persistent NP deficits were observed in 59 (62.8%) patients. Age, gender, Centers for Disease Control and Prevention stage, risk category, CD4 cell count, plasma viral load, and use of central nervous system-penetrating drugs were not associated with persistent NP deficits. By contrast, patients with persistent NP deficits were less educated and showed poorer baseline performances in NP measures exploring concentration and speed of mental processing, memory, and mental flexibility. In multivariable analyses, only the baseline severity of NCI, as measured by the composite NPZ8 global score (odds ratio = 3.07, 95% confidence interval: 1.54 to 6.08; P = 0.001) remained significantly associated with persistent NP deficits.
  
  
  CONCLUSIONS
  The severity of NCI at HAART initiation seems to be the strongest predictor of persistent NP deficits despite long-term HAART. Our data indicate that HAART should be initiated as soon as NCI is diagnosed to avoid potentially irreversible neurologic damage.
authors.affiliation: National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, Rome, Italy. tozzi@inmi.it
authors.forename: Valerio
authors.initials: V
authors.lastname: Tozzi
authors.forename: Pietro
authors.initials: P
authors.lastname: Balestra
authors.forename: Rita
authors.initials: R
authors.lastname: Bellagamba
authors.forename: Angela
authors.initials: A
authors.lastname: Corpolongo
authors.forename: Maria Flora
authors.initials: MF
authors.lastname: Salvatori
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Visco-Comandini
authors.forename: Chrysoula
authors.initials: C
authors.lastname: Vlassi
authors.forename: Marinella
authors.initials: M
authors.lastname: Giulianelli
authors.forename: Simonetta
authors.initials: S
authors.lastname: Galgani
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Pasquale
authors.initials: P
authors.lastname: Narciso
mesh_terms: D015526:AIDS Dementia Complex / Q000517:prevention & control*; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D004334:Drug Administration Schedule; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D009483:Neuropsychological Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents