| Publication Abstract Display | | Type: Published Abstract | | Title: Overview of HIV Associated Neurocognitive Disorders (HAND): Findings from the Six-Site CNS HIV Anti-Retroviral Effects Research (CHARTER). | | Authors: Heaton RK, Letendre S, Collier A, Clifford D, Gellman B, Marra C, Morgello S, McArthur J, McCutchan A, Simpson D, Franklin D, Grant I, for the CHARTER Group | | Year: 2013 | | Publication: 2013 Mid-Year Meeting International Neuropsychological Society | | Volume: Issue: Pages: | | Abstract:Objective: We will provide an overview of HIV-Associated Neurocognitive Disorders (HAND), using data from a large sample of HIV-infected (HIV+) adults recruited without exclusions from six university-based clinical settings in the U.S.
Method/Participants: All participants (N=1555) received standardized, comprehensive neuropsychological (NP) and neuro-medical assessments at baseline, and comparable, semi-annual follow-up assessments were conducted with a subset of this group (n=438). Published international criteria were used to classify participants with respect to HAND status and three levels of comorbidity (conditions other than HIV that could affect CNS functioning and NP test results).
Results: At baseline, HAND was present in 40% of participants with minimal comorbidities (n=843) and 59% of those with moderate comorbidities (n=473); an 83% NP impairment rate was seen in participants having severe comorbidities (n=239) that preclude HAND diagnoses. Prior history of severe immunosuppression and failure to achieve viral suppression on anti-retroviral treatment (ART) increased risk for HAND, but only in participants with minimal comorbidities. NP decline over an average follow-up of 36 months occurred in 23% of participants. Such decline was predicted by comorbidity level (minimal to severe) and by time-dependent treatment status (on-off), degree of immunosuppression, and HIV viral load.
Conclusions: The current era of combination ART has witnessed greatly improved life expectancy and medical morbidity in HIV+ people, but mild-to-moderate forms of HAND remain highly prevalent. History of serious immunosuppression increases risk for HAND throughout the disease course, and should be minimized by early and consistent use of ART. Comorbidity levels should be carefully assessed and monitored because higher levels of comorbidity increase risk for HAND and further NP decline over time. |
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