Longitudinally preserved psychomotor performance in long-term asymptomatic HIV-infected individuals.
BACKGROUND
Recent case reports have suggested that some asymptomatic HIV-infected individuals can develop CNS disturbances despite intact immunologic functioning and long-term suppression of plasma HIV concentrations to undetectable levels. This possibility has not yet been systematically studied longitudinally.


METHODS
Using longitudinal data from the Multicenter AIDS Cohort Study, we investigated neuropsychological performance in long-term asymptomatic HIV-infected men who have sex with men. Performance over a 5-year period on the Symbol Digit Modalities test and the Trail Making Tests were compared in three HIV-positive asymptomatic groups [defined as 1) highly active antiretroviral therapy (HAART) treated with undetectable viral loads (n = 83), 2) AIDS-free for more than 15 years without HAART (n = 29), and 3) absence of clinical AIDS or CD4(+) lymphocyte count below 200 cells/muL at the beginning and end of the study period (n = 233)] and in HIV-negative controls (n = 237). Data were analyzed using linear mixed models and proportional odds logistic regression modeling with generalized estimating equations.


RESULTS
There was no evidence of performance differences or performance declines over the 5-year period of study in any of the three long-term asymptomatic groups as compared with the HIV-negative group in the Symbol Digit Modalities test or the Trail Making Tests. Performance decrements were, however, observed with increasing age in each of the tests administered, demonstrating that performance declines could be detected by these methods.


CONCLUSIONS
Regardless of how long-term asymptomatic status was defined immunologically or virologically, neuropsychological test performances remained stable. These findings suggest that psychomotor speed is preserved over many years in HIV-infected individuals with controlled HIV viremia.
Cole
M A
MA
Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. colema@hawaii.edu.
Margolick
J B
JB
Cox
C
C
Li
X
X
Selnes
O A
OA
Martin
E M
EM
Becker
J T
JT
Aronow
H A
HA
Cohen
B
B
Sacktor
N
N
Miller
E N
EN
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000639:trends; D015331:Cohort Studies; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology / Q000523:psychology*; D006679:HIV Seropositivity / Q000097:blood / Q000175:diagnosis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011597:Psychomotor Performance / Q000502:physiology; D013995:Time