title: HIV DNA and cognition in a Thai longitudinal HAART initiation cohort: the SEARCH 001 Cohort Study.
abstract: OBJECTIVE
  The extent to which highly active antiretroviral therapy (HAART) era cognitive disorders are due to active processes, incomplete clearance of reservoirs, or comorbidities is controversial. This study aimed to determine if immunologic and virologic factors influence cognition after first-time HAART in Thai individuals with HIV-associated dementia (HAD) and Thai individuals without HAD (non-HAD).
  
  
  METHODS
  Variables were captured longitudinally to determine factors predictive of degree of cognitive recovery after first-time HAART. Neuropsychological data were compared to those of 230 HIV-negative Thai controls.
  
  
  RESULTS
  HIV RNA and CD4 lymphocyte counts were not predictive of HAD cross-sectionally or degree of cognitive improvement longitudinally. In contrast, baseline and longitudinal HIV DNA isolated from monocytes correlated to cognitive performance irrespective of plasma HIV RNA and CD4 lymphocyte counts pre-HAART (p < 0.001) and at 48 weeks post HAART (p < 0.001). Levels exceeding 3.5 log(10) copies HIV DNA/10(6) monocyte at baseline distinguished all HAD and non-HAD cases (p < 0.001). At 48 weeks, monocyte HIV DNA was below the level of detection of our assay (10 copies/10(6) cells) in 15/15 non-HAD compared to only 4/12 HAD cases, despite undetectable plasma HIV RNA in 26/27 cases. Baseline monocyte HIV DNA predicted 48-week cognitive performance on a composite score, independently of concurrent monocyte HIV DNA and CD4 count (p < 0.001).
  
  
  CONCLUSIONS
  Monocyte HIV DNA level correlates to cognitive performance before highly active antiretroviral therapy (HAART) and 48 weeks after HAART in this cohort and baseline monocyte HIV DNA may predict 48-week cognitive performance. These findings raise the possibility that short-term incomplete cognitive recovery with HAART may represent an active process related to this peripheral reservoir.
authors.affiliation: Hawaii AIDS Clinical Research Program, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96816, USA. Vvalcour@hawaii.edu
authors.forename: V G
authors.initials: VG
authors.lastname: Valcour
authors.forename: B T
authors.initials: BT
authors.lastname: Shiramizu
authors.forename: P
authors.initials: P
authors.lastname: Sithinamsuwan
authors.forename: S
authors.initials: S
authors.lastname: Nidhinandana
authors.forename: S
authors.initials: S
authors.lastname: Ratto-Kim
authors.forename: J
authors.initials: J
authors.lastname: Ananworanich
authors.forename: U
authors.initials: U
authors.lastname: Siangphoe
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.forename: M
authors.initials: M
authors.lastname: de Souza
authors.forename: V
authors.initials: V
authors.lastname: Degruttola
authors.forename: R H
authors.initials: RH
authors.lastname: Paul
authors.forename: C M
authors.initials: CM
authors.lastname: Shikuma
mesh_terms: D015526:AIDS Dementia Complex / Q000097:blood* / Q000523:psychology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002469:Cell Separation; D003071:Cognition; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006678:HIV / Q000235:genetics*; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D009000:Monocytes / Q000378:metabolism; D009483:Neuropsychological Tests; D011446:Prospective Studies; D013785:Thailand
chemical_list: D004279:DNA, Viral; D018950:Lipopolysaccharide Receptors