Publication Abstract Display | Type: Poster | Title: HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy. | Authors: Heaton R, Franklin D, Ellis RJ, Letendre S, LeBlanc S, Woods SP, Clifford D, Rivera-Mindt M, Taylor M, Marcotte T, Atkinson JH, Collier A, Marra CM, Gelman B, McArthur J, Morgello S, Simpson D, McCutchan JA, Grant I, for the CHARTER and HNRC Groups | Date: 02-02-2011 | Abstract:Background:
CART has greatly reduced medical mordbidity and mortality in HIV, but there is evidence that neurological complications remain common
Lack of large scale, neurological studies with comparable methodologies for pre-CART versus CART make accurate estimates of the prevalence of HAND in the pre-CART and CART eras difficult
DESIGN
857 individuals (HIV-, n=179; non-AIDS, n=516; AIDS, n=162) from the pre-CART era (1990-1995) were compared to 937 individuals (HIV-, n=94; non-AIDS, n=336; AIDS, n=506) from the CART era (2000-2007) on the basis of having received comparable comprehensive neuromedical and neuropsychological (NP) evaluations
SUBJECTS
Inclusion: HIV-uninfected; HIV-infected and on/off ART
Exclusion: Comorbid conditions that may cause neuropsychological impairment independent of HIV
ASSESSMENTS
Comprehensive, standardized NP assessment of 7 cognitive domains
NP test scores are all corrected for relevant demographic characteristics (age, education, gender and Caucasian vs African-American ethnicity, as appropriate); consistent with international criteria for diagnosing HAND, “NP Impairment” required presence of at least mild impairment of ≥ 2 ability domains
Neuromediccal examinations according to a standardized protocol
Conclusions:
NCI remains prevalent despite CART.
Asymptomatic, non-AIDS (CDC class A) patients have more HAND in the CART era than in the pre-CART era.
Longer survival on CART may allow continued brain damage from undetected HIV replication, chronic inflammation or immune-mediated degeneration in the CNS.
Reasons for observed HAND pattern differences in pre-CART vs CART era are currently unknown, but would be consistent with some shift to relatively greater cortical involvement. Neuroimaging and neuropathology studies should explore this possibility. |
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