title: Antiretroviral treatment initiation does not differentially alter neurocognitive functioning over time in youth with behaviorally acquired HIV.
abstract: Although youth living with behaviorally acquired HIV (YLWH) are at risk for cognitive impairments, the relationship of impairments to HIV and potential to improve with antiretroviral therapy (ART) are unclear. This prospective observational study was designed to examine the impact of initiation and timing of ART on neurocognitive functioning in YLWH in the Adolescent Medicine Trials Network for HIV/AIDS Interventions. Treatment naïve YLWH age 18-24 completed baseline and four additional assessments of attention/working memory, complex executive, and motor functioning over 3 years. Group 1 co-enrolled in an early ART initiation study and initiated ART at enrollment CD4 >350 (n = 56); group 2 had CD4 >350 and were not initiating ART (n = 66); group 3 initiated ART with CD4 <350 (n = 59) per standard of care treatment guidelines at the time. Treatment was de-intensified to boosted protease inhibitor monotherapy at 48 weeks for those in group 1 with suppressed viral load. Covariates included demographic, behavioral, and medical history variables. Analyses used hierarchical linear modeling. All groups showed improved performance with peak at 96 weeks in all three functional domains. Trajectories of change were not significantly associated with treatment, timing of treatment initiation, or ART de-intensification. Demographic variables and comorbidities were associated with baseline functioning but did not directly interact with change over time. In conclusion, YLWH showed improvement in neurocognitive functioning over time that may be related to practice effects and nonspecific impact of study participation. Neither improvement nor decline in functioning was associated with timing of ART initiation or therapy de-intensification.
authors.affiliation: Department of Neurosciences, University of California, 9500 Gilman Drive, #0935, La Jolla, San Diego, CA, 92093, USA. slnichols@ucsd.edu.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Nichols
authors.affiliation: Westat, Rockville, MD, USA.
authors.forename: James
authors.initials: J
authors.lastname: Bethel
authors.affiliation: National Institutes of Health, Bethesda, MD, USA.
authors.forename: Bill G
authors.initials: BG
authors.lastname: Kapogiannis
authors.affiliation: Westat, Rockville, MD, USA.
authors.forename: Tiandong
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Woods
authors.affiliation: Children's Diagnostic & Treatment Center, Inc., Ft. Lauderdale, FL, USA.
authors.forename: E Doyle
authors.initials: ED
authors.lastname: Patton
authors.affiliation: Westat, Rockville, MD, USA.
authors.forename: Weijia
authors.initials: W
authors.lastname: Ren
authors.affiliation: Westat, Rockville, MD, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Thornton
authors.affiliation: Department of Pediatrics, University of Miami, Miami, FL, USA.
authors.forename: Hanna O
authors.initials: HO
authors.lastname: Major-Wilson
authors.affiliation: Children's Diagnostic & Treatment Center, Inc., Ft. Lauderdale, FL, USA.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Puga
authors.affiliation: Division of Allergy and Immunology, Duke University, Durham, NC, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Sleasman
authors.affiliation: Department of Pediatrics, New York University, New York, NY, USA.
authors.forename: Bret J
authors.initials: BJ
authors.lastname: Rudy
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Wilson
authors.affiliation: Children's Diagnostic & Treatment Center, Inc., Ft. Lauderdale, FL, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Garvie
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001288:Attention / Q000187:drug effects; D018791:CD4 Lymphocyte Count; D060825:Cognitive Dysfunction / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D004334:Drug Administration Schedule; D056344:Executive Function / Q000187:drug effects; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D015233:Models, Statistical; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects; D013997:Time Factors; D019562:Viral Load / Q000187:drug effects; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Adolescent; Antiretroviral therapy; HIV; HIV-associated neurocognitive disorder; Neurocognitive functioning; Youth