| Publication Abstract Display | | Type: Poster | | Title: Persistence and progression of HIV-associated neurocognitive impairment (NCI) in the era of combination antiretroviral therapy (CART) and the role of comorbidities: The CHARTER Study. | | Authors: Heaton RK, Franklin DR, Clifford D, Woods SP, Mindt MR, Vigil OR, Taylor MJ, Marcotte TD, Atkinson JH, Grant I, and the CHARTER Group | | Date: 10-2009 | | Abstract:Introduction: CART typically suppresses HIV viral
replication in plasma and CSF, but its long-term
effects on NCI are unclear. This multi-site study
examined the prevalence and predictors of NCI in
the CART era, within an HIV sample reflective of
clinic populations with varying degrees of comorbidity.
Methods: 1555 HIV-infected patients at six university
clinics across the US received comprehensive
neuromedical and neuropsychological (NP)
evaluations. Participants were classified according
to severity of their comorbidity (factors which could
contribute to, or cause, NCI independent of HIV:
minimal, n843; moderate, n473; and severe,
n239.
Results: Overall, 53% of the cohort had NCI based
on NP testing, with rates increased in groups with
greater comorbidity (minimal [39%], moderate
[54%] and severe [79%]; all p’s B.01). Associations
between NCI and both markers of disease severity
and CART-related viral suppression were found
only in the group with minimal comorbidity, such
that those on CART who achieved undetectable
plasma viral load, and whose CD4 was never below
200 were most cognitively intact. In a 6-month
follow-up of 680 patients, each successive comorbidity
group had a higher rate of cognitive decline
(11% vs. 18% vs. 27%, respectively; pB.05).
Conclusions: Despite most being on CART, there
was a high prevalence of NCI. At baseline, nadir CD4
and successful viral suppression were related to NCI
only in patients without significant comorbidities.
However, cognitive decline over time was found
to occur more frequently in patients with greater
comorbidity. Thus, both HIV and comorbidity
contribute to NCI in the CART era, and CNS
comorbidities may increase risk of subsequent HIVrelated
cognitive decline. |
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