HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study.
OBJECTIVE
This is a cross-sectional, observational study to determine the frequency and associated features of HIV-associated neurocognitive disorders (HAND) in a large, diverse sample of infected individuals in the era of combination antiretroviral therapy (CART).


METHODS
A total of 1,555 HIV-infected adults were recruited from 6 university clinics across the United States, with minimal exclusions. We used standardized neuromedical, psychiatric, and neuropsychological (NP) examinations, and recently published criteria for diagnosing HAND and classifying 3 levels of comorbidity (minimal to severe non-HIV risks for NP impairment).


RESULTS
Fifty-two percent of the total sample had NP impairment, with higher rates in groups with greater comorbidity burden (40%, 59%, and 83%). Prevalence estimates for specific HAND diagnoses (excluding severely confounded cases) were 33% for asymptomatic neurocognitive impairment, 12% for mild neurocognitive disorder, and only 2% for HIV-associated dementia (HAD). Among participants with minimal comorbidities (n = 843), history of low nadir CD4 was a strong predictor of impairment, and the lowest impairment rate on CART occurred in the subset with suppressed plasma viral loads and nadir CD4 ≥200 cells/mm(3) (30% vs 47% in remaining subgroups).


CONCLUSIONS
The most severe HAND diagnosis (HAD) was rare, but milder forms of impairment remained common, even among those receiving CART who had minimal comorbidities. Future studies should clarify whether early disease events (e.g., profound CD4 decline) may trigger chronic CNS changes, and whether early CART prevents or reverses these changes.
University of California, San Diego, USA. rheaton@ucsd.edu
R K
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Heaton
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Clifford
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Franklin
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Woods
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Ake
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Vaida
R J
RJ
Ellis
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Letendre
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Marcotte
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Atkinson
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Rivera-Mindt
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Vigil
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Taylor
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Collier
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Marra
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Gelman
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McArthur
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Morgello
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Simpson
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McCutchan
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Abramson
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Gamst
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Fennema-Notestine
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Jernigan
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Wong
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Grant
D000203:Activities of Daily Living; D000328:Adult; D000465:Algorithms; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D003072:Cognition Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D018592:Cross-Over Studies; D004185:Disability Evaluation; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009460:Neurologic Examination / Q000379:methods; D009483:Neuropsychological Tests; D019370:Observation; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies