Cognitive disorders in HIV-infected patients:  are they HIV-related?
OBJECTIVE
Large unselected studies on representative samples of HIV-infected patients with a whole battery of neuropsychological tests and cerebral MRI scan are required to assess the frequency of neurocognitive impairment (NCI), the determinants of mild neurocognitive disorders (MNDs), or HIV-associated dementia (HAD) and the relationship between NCI and MRI scan findings.


METHODS
Investigation of 400 consecutively enrolled HIV-1-infected adults from the ANRS CO3 Aquitaine Cohort, using standardized neurocognitive tests chosen to achieve consistency with Frascati's criteria. Half of the patients had a cerebral MRI scan allowing gray and white matter volume measurement. Factors associated with NCI were studied by logistic regression models.


RESULTS
Median age of participants was 47 years, 79% were male and 89% received combination antiretroviral treatment (cART), of whom 93% had plasma HIV RNA below 500 copies/ml. Median CD4 cell count was 515 cells/μl. Prevalence of NCI was 59%, including 21% of asymptomatic NCI, 31% of MND, and 7% of HAD. A low level of education, prior neurologic AIDS-defining disorders event, anxiety, depressive symptoms, and prior history of brain damage were independently associated with MND or HAD, but neither HIV nor cART-related variables. The presence of NCI was significantly associated with lower gray matter fraction.


CONCLUSIONS
In this large unselected cohort, a high prevalence of symptomatic neurocognitive disorders was mainly related to its traditional determinants and associated with gray matter atrophy at early stages of the disease.
Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André , CHU Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux cedex, France. fabrice.bonnet@chu-bordeaux.fr
Fabrice
F
Bonnet
Hélène
H
Amieva
Fabienne
F
Marquant
Charlotte
C
Bernard
Mathias
M
Bruyand
Frédéric-Antoine
FA
Dauchy
Patrick
P
Mercié
Carine
C
Greib
Laura
L
Richert
Didier
D
Neau
Gwenaelle
G
Catheline
Patrick
P
Dehail
Francois
F
Dabis
Philippe
P
Morlat
Jean-François
JF
Dartigues
Geneviève
G
Chêne
D015526:AIDS Dementia Complex / Q000453:epidemiology / Q000473:pathology*; D023241:Antiretroviral Therapy, Highly Active; D001284:Atrophy; D015992:Body Mass Index; D001921:Brain / Q000473:pathology* / Q000821:virology; D018791:CD4 Lymphocyte Count; D003072:Cognition Disorders / Q000453:epidemiology / Q000473:pathology* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood / Q000302:isolation & purification; D011795:Surveys and Questionnaires
D012367:RNA, Viral