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Neurocognitive Issues Plague HIV-Infected Patients Taking Antiretroviral Therapy: Presented at IDSA

By Ed Susman

PHILADELPHIA -- November 1, 2009 -- Neurocognitive impairment -- frequently seen among untreated subjects with HIV -- appears to persist among a substantial minority of patients treated with highly active antiretroviral therapy (HAART), according to researchers presenting here at the 47th Annual Meeting of the Infectious Diseases Society of America (IDSA).

"The introduction of HAART reduced the incidence of HIV-associated dementia by about 50%," said Abayomi Agbebi, MD, Washington University School of Medicine, St. Louis, Missouri. "Paradoxically, HAART does not reverse cognitive impairment in all patients."

Dr. Agbebi and colleagues found that 23% of HIV-infected subjects -- 182 of 793 patients -- attending the Washington University HIV clinic in 2008 in this prospective cross-sectional study had neurocognitive impairment, despite being on outpatient treatment with antiretroviral therapy.

"In the era of HAART, the prevalence of HIV-associated neurocognitive impairment remains high," Dr. Agbebi reported in a poster presentation here on October 30.

The research team conducted a multivariate analysis of factors that were associated with persistent neurocognitive impairment and found that older age (40+ years) and lower education (defined as people without a college-level degree) were significantly associated with cognitive impairment (P < .05).

"Persons with a college degree had a lower prevalence of cognitive impairment," Dr. Agbebi said. "Aging is a significant risk factor for cognitive impairment. As the HIV cohort ages, further investigation is needed into the effects of aging on HIV cognitive impairment."

The researchers found no association between neurocognitive impairment and gender, ethnicity, coinfection with hepatitis C, excess alcoholic intake, CD4-positive cell count, type of antiretroviral regimen, or whether a patient was taking an antiretroviral therapy that had central nervous system-penetrating agents.

"Multiple studies have shown certain antiretrovirals achieve a higher concentration in the cerebrospinal fluid," Dr. Agbebi noted. "Based on current evidence, antiretroviral cerebrospinal fluid levels cannot be used to choose a regimen."

The researchers added that the effect of high levels of antiretrovirals in cerebrospinal fluid remains controversial.

Funding for this study was provided by a grant from Bristol-Myers Squibb.

[Presentation title: HIV-Associated Neurocognitive Impairment Remains Prevalent in the Era of HAART. Abstract 351]

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