The incidence of and risk factors for HIV-associated cognitive-motor complex among patients on HAART.
BACKGROUND
While highly active antiretroviral therapy (HAART) allows for the considerable decline in the incidence of HIV-related opportunistic infections and tumors, its effect on treating HIV infection of the brain, such as HIV-associated dementias (HADs), remains unclear.


METHODS
A cross-sectional study of consecutive series of 96 patients from the Serbian HIV/AIDS cohort, treated with HAART in our HIV unit was performed to evaluate the incidence of and risk factors for cognitive/motor complex during HAART. CD4+T cell counts and pVL values at the time of neurological evaluation were parameters of the response to HAART. The mini-mental test and neurologic examination were performed at one point of time during treatment to reveal cognitive and/or motor disorders.


RESULTS
After mean HAART duration of 47 months, unimpaired cognition, minor cognitive impairment, and HIV-associated dementia were recorded in 56 (58.3%), 27 (28.1%), and 13 (13.5%), respectively. Motor abnormalities had 39 (40.6%) patients. Of these, 21, 12, and 6 patients belong to the subgroups with normal cognition, minor cognitive impairment and HAD patients, respectively. Factors predictive for HAD were age over 40 (OR 3.7, 95% CI 1.07-13.28, P=0.039), and AIDS diagnosis prior to HAART initiation (OR 14.19, 95% CI 1.76-114.16, P=0.013). Conversely, factors shown to be protective against HAD were the usage of AZT and NNRTIs, as components of HAART regimens (OR 0.18, 95% CI 0.046-0.76, P=0.019, and OR 0.14, 95% CI 0.034-0.6, P=0.008).


CONCLUSIONS
Cognitive/motor complex has still remained a significant neuropathology among late presenters and elder HIV/AIDS patients. Certain HAART regimens containing AZT, and/or NNRTIs, could be protective for these patients.
Jevtović
Dj
Dj
HIV/AIDS Department, Institute for Infectious and Tropical Diseases, Belgrade University School of Medicine, Clinical Centre of Serbia, Bulevar Oslobodjenja 16, 11000 Belgrade, Serbia. djordjejevtovic@hotmail.com
Vanovac
V
V
Veselinović
M
M
Salemović
D
D
Ranin
J
J
Stefanova
E
E
D015526:AIDS Dementia Complex / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology / Q000821:virology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003071:Cognition / Q000187:drug effects; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000187:drug effects; D009460:Neurologic Examination; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D016017:Odds Ratio; D011569:Psychiatric Status Rating Scales; D012367:RNA, Viral / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D055771:Serbia; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
D019380:Anti-HIV Agents; D018696:Neuroprotective Agents; D012367:RNA, Viral