Neuropsychological Impairment in Acute HIV and the Effect of Immediate Antiretroviral Therapy.
OBJECTIVE
To investigate neuropsychological performance (NP) during acute HIV infection (AHI) before and after combination antiretroviral therapy (cART).


METHODS
Prospective study of Thai AHI participants examined at 3 and 6 months after initiation of cART.


METHODS
Thirty-six AHI participants were evaluated pre-cART at median 19 days since HIV exposure and 3 and 6 months after cART with the Grooved Pegboard test, Color Trails 1 & 2 (CT1, CT2), and Trail Making Test A. Raw scores were standardized to 251 age- and education-matched HIV-uninfected Thais. To account for learning effects, change in NP performance was compared with that of controls at 6 months. Analyses included multivariable regression, nonparametric repeated measures analysis of variance, and Mann-Whitney U test.


RESULTS
Baseline NP scores for the AHI group were within normal range (z-scores range: -0.26 to -0.13). NP performance improved on CT1, CT2, and Trail Making Test A in the initial 3 months (P < 0.01) with no significant change during the last 3 months. Only improvement in CT1 was greater than that seen in controls at 6 months (P = 0.018). Participants who performed >1 SD below normative means on ≥2 tests (n = 8) exhibited higher baseline cerebrospinal fluid HIV RNA (P = 0.047) and had no improvement after cART.


CONCLUSIONS
Most AHI individuals had normal NP performance, and early cART slightly improved their psychomotor function. However, approximately 25% had impaired NP performance, which correlated with higher cerebrospinal fluid HIV RNA, and these abnormalities were not reversed by early cART possibly indicating limited reversibility of cognitive impairment in a subset of AHI individuals.
*Yale University School of Medicine, New Haven, CT; †SEARCH, The Thai Red Cross AIDS Research Center, Bangkok, Thailand; ‡US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; §Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD; ‖University of California, San Francisco, CA; ¶Missouri Institute of Mental Health, University of Missouri, St. Louis, MO; #Yale Center for Analytical Sciences, New Haven, CT; and **HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand.
Idil
I
Kore
Jintanat
J
Ananworanich
Victor
V
Valcour
James L K
JL
Fletcher
Thep
T
Chalermchai
Robert
R
Paul
Jesse
J
Reynolds
Somporn
S
Tipsuk
Sasiwimol
S
Ubolyam
Somprartthana
S
Rattanamanee
Linda
L
Jagodzinski
Jerome
J
Kim
Serena
S
Spudich
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000473:pathology* / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009422:Nervous System Diseases / Q000188:drug therapy* / Q000473:pathology*; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011596:Psychomotor Disorders / Q000188:drug therapy* / Q000503:physiopathology*; D013785:Thailand; D016896:Treatment Outcome; D055815:Young Adult
D044966:Anti-Retroviral Agents