Dynamics of cognitive change in impaired HIV-positive patients initiating antiretroviral therapy.
OBJECTIVE
To rigorously evaluate the time course of cognitive change in a cohort of individuals with HIV-associated neurocognitive disorders (HAND) initiating combination antiretroviral therapy (CART), and to investigate which demographic, laboratory, and treatment factors are associated with neuropsychological (NP) outcome (or "any NP improvement").


METHODS
Study participants included 37 HIV+ individuals with mild to moderate NP impairment who initiated CART and underwent NP testing at 12, 24, 36, and 48 weeks thereafter. NP change was assessed using a regression-based change score that was normed on a separate NP-stable group thereby controlling for regression toward the mean and practice effect. Mixed-effect regression models adjusting for loss to follow-up were used to evaluate the time course of cognitive change and its association with baseline and time-varying predictors.


RESULTS
In persons with HAND initiating CART, cognitive improvement happens soon after initiation (13% at week 12), but more often 24, 36, and up to 48 weeks after initiation (up to 41%), with fewer than 5% demonstrating significant worsening. In multivariate analyses, unique predictors of NP improvement included more severe baseline NP impairment and higher CART CNS penetration index. Greater viral load decrease was associated with NP improvement only in univariate analyses.


CONCLUSIONS
Clinically meaningful neuropsychological improvement seemed to peak around 24-36 weeks after combination antiretroviral therapy initiation and was prolonged over the 1-year study period. This study also provides new evidence that benefit may be maximized by choosing antiretroviral medications that reach therapeutic concentrations in the CNS.
Cysique
L A
LA
Department of Psychiatry, University of California at San Diego, CA, USA. lcysique@unsw.edu.au
Vaida
F
F
Letendre
S
S
Gibson
S
S
Cherner
M
M
Woods
S P
SP
McCutchan
J A
JA
Heaton
R K
RK
Ellis
R J
RJ
D015526:AIDS Dementia Complex / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods* / Q000706:statistics & numerical data*; D001812:Blood-Brain Barrier / Q000187:drug effects / Q000502:physiology; D001921:Brain / Q000187:drug effects / Q000503:physiopathology / Q000821:virology; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D003072:Cognition Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology*; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care / Q000379:methods; D011379:Prognosis; D020127:Recovery of Function / Q000187:drug effects / Q000276:immunology; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult