| Publication Abstract Display | | Type: Poster | | Title: Earlier initiation of antiretroviral therapy results in better neurocognitive functioning. | | Authors: Marcotte T, Ghate M, Deutsch R, Letendre S, Meyer R, Godbole S, Risbud A, Thakar M, Grant I, Mehendale S | | Date: 03-05-2012 | | Abstract:Background: Combination antiretroviral treatment (ART) has significantly reduced the severity of HIV-associated neurocognitive disorder (HAND), although mild forms of neuropsychological impairment remain common. In many regions treatment is often initiated only after patients show immunocompromise (e.g., CD4 < 350). The goal of this study was to determine whether initiating ART at higher CD4 cell counts benefits neurocognitive functioning.
Methods: HIV+ participants in Pune, Maharashtra, India with a CD4 cell count > 350/mm3 and enrolled in a separate study (HPTN 052) were randomized to immediate (n = 35) or deferred treatment (n = 44). All participants completed a full NP battery (translated into Marathi) at baseline and a 1-year follow-up. NP performance was summarized using unadjusted mean scaled scores (mSS), a normalized score that puts all scores on the same metric (higher scores indicate better performance).
Results: The two groups were similar with respect to age (~33 years), education (~ 9 years), gender (67% male), and disease stage (84% CDC A), and had comparably high current CD4 cell counts (~ 460/mm3). On average, participants started treatment on the day they were tested (median days between testing and treatment = 0 [-12, 1]). At baseline, the mSS for the deferred treatment group was 9.0 (1.9) vs. 9.7 (1.5) for the treated group (p = .06). All participants in the treated group attained virologic suppression by their second visit. In a multivariable model, improvement in mSS was predicted by the interaction of group and 1) baseline mSS (p = .02) and 2) time on treatment (p = .002). Treated participants with the lowest baseline mSS and longest period of treatment demonstrated the most improvement. Whether the participants started treatment prior to baseline was not a significant predictor.
Conclusions: ART initiation at higher CD4 cell counts appears to benefit the central nervous system. This finding was present despite 45% of the treated participants starting treatment prior to the baseline assessment (most within a few weeks), a conservative bias. Future analyses of larger sample sizes of participants with or without HAND will generate more robust evidence regarding the possible cognitive benefit of early ART initiation. |
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