title: Neurocognitive function in HIV infected patients on antiretroviral therapy.
abstract: OBJECTIVE
  To describe factors associated with neurocognitive (NC) function in HIV-positive patients on stable combination antiretroviral therapy.
  
  
  METHODS
  We undertook a cross-sectional analysis assessing NC data obtained at baseline in patients entering the Protease-Inhibitor-Monotherapy-Versus-Ongoing-Triple therapy (PIVOT) trial.
  
  
  METHODS
  NC testing comprised of 5 domains. Raw results were z-transformed using standard and demographically adjusted normative datasets (ND). Global z-scores (NPZ-5) were derived from averaging the 5 domains and percentage of subjects with test scores >1 standard deviation (SD) below population means in at least two domains (abnormal Frascati score) calculated. Patient characteristics associated with NC results were assessed using multivariable linear regression.
  
  
  RESULTS
  Of the 587 patients in PIVOT, 557 had full NC results and were included. 77% were male, 68% Caucasian and 28% of Black ethnicity. Mean (SD) baseline and nadir CD4+ lymphocyte counts were 553(217) and 177(117) cells/µL, respectively, and HIV RNA was <50 copies/mL in all. Median (IQR) NPZ-5 score was -0.5 (-1.2/-0) overall, and -0.3 (-0.7/0.1) and -1.4 (-2/-0.8) in subjects of Caucasian and Black ethnicity, respectively. Abnormal Frascati scores using the standard-ND were observed in 51%, 38%, and 81%, respectively, of subjects overall, Caucasian and Black ethnicity (p<0.001), but in 62% and 69% of Caucasian and Black subjects using demographically adjusted-ND (p = 0.20). In the multivariate analysis, only Black ethnicity was associated with poorer NPZ-5 scores (P<0.001).
  
  
  CONCLUSIONS
  In this large group of HIV-infected subjects with viral load suppression, ethnicity but not HIV-disease factors is closely associated with NC results. The prevalence of abnormal results is highly dependent on control datasets utilised.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT01230580.
authors: Section of Infectious Diseases, Division of Medicine, Imperial College London, St Mary's Hospital Campus, Norfolk Place, London, United Kingdom. a.winston@imperial.ac.uk
authors: Alan
authors: A
authors: Winston
authors: Alejandro
authors: A
authors: Arenas-Pinto
authors: Wolfgang
authors: W
authors: Stöhr
authors: Martin
authors: M
authors: Fisher
authors: Chloe M
authors: CM
authors: Orkin
authors: Kazeem
authors: K
authors: Aderogba
authors: Andrew
authors: A
authors: De Burgh-Thomas
authors: Nigel
authors: N
authors: O'Farrell
authors: Charles Jn
authors: CJ
authors: Lacey
authors: Clifford
authors: C
authors: Leen
authors: David
authors: D
authors: Dunn
authors: Nicholas I
authors: NI
authors: Paton
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D044383:Black People; D003071:Cognition; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012307:Risk Factors; D044465:White People
references: J Neurovirol. 2011 Feb;17(1):3-16
references: 21174240
references: Clin Microbiol Infect. 2010 Oct;16(10):1579-84
references: 20132257
references: Qual Life Res. 2005 May;14(4):971-80
references: 16041894
references: J Clin Exp Neuropsychol. 2011 Oct;33(8):853-63
references: 21950512
references: J Clin Exp Neuropsychol. 2012;34(1):78-91
references: 22082040
references: J Neurovirol. 2011 Apr;17(2):176-83
references: 21416169
references: Arch Neurol. 2008 Jan;65(1):65-70
references: 18195140
references: AIDS. 1999 Sep 10;13(13):1677-85
references: 10509569
references: AIDS Behav. 2011 Aug;15(6):1197-203
references: 20614176
references: J Clin Exp Neuropsychol. 2011 Aug;33(7):793-804
references: 21547817
references: HIV Med. 2010 May;11(5):334-44
references: 20136661
references: HIV Med. 2012 Apr;13(4):245-51
references: 22151608
references: Clin Neuropsychol. 1999 Aug;13(3):348-58
references: 10726605
references: Neurology. 2007 Oct 30;69(18):1789-99
references: 17914061
references: Clin Neuropsychol. 2004 May;18(2):234-48
references: 15587671
references: AIDS. 2011 Sep 10;25(14):1747-51
references: 21750419
references: Neurology. 2004 Mar 23;62(6):957-62
references: 15037699
references: Clin Infect Dis. 2011 Oct;53(8):836-42
references: 21921226
references: Neurology. 2011 Apr 19;76(16):1403-9
references: 21502598
references: AIDS. 2007 Sep 12;21(14):1915-21
references: 17721099
references: J Pharmacol Exp Ther. 2006 May;317(2):746-51
references: 16424147
references: J Int Neuropsychol Soc. 2011 Nov;17(6):956-69
references: 21813033
references: AIDS. 2004 Jan 1;18 Suppl 1:S11-8
references: 15075493
references: Clin Infect Dis. 2010 Mar 15;50(6):920-9
references: 20146627
references: HIV Med. 2010 Aug;11(7):432-8
references: 20146736
references: Eur J Neurol. 2011 Mar;18(3):527-34
references: 21159073
references: Neurology. 2009 Aug 4;73(5):342-8
references: 19474412
references: HIV Clin Trials. 2011 Nov-Dec;12(6):333-8
references: 22189152
references: Heart. 2005 Dec;91 Suppl 5:v1-52
references: 16365341
references: AIDS. 1999 Jul 9;13(10):1249-53
references: 10416530