| Publication Abstract Display | | Type: Published Abstract | | Title: The roles of HIV RNA viral load and highly active antiretroviral treatment (HAART) in incident HIV-associated neuropsychological impairment. | | Authors: Rivera Mindt M, Ellis R, Moore DJ, Heaton RK, Deutsch R, Grant I, and the HNRC Group | | Year: 2002 | | Publication: Journal of the International Neuropsychological Society | | Volume: 8 Issue: 2 Pages: 314 | | Abstract:Previous cross-sectional studies indicate that HIV-associated neuropsychological (NP) impairment is related to elevated HIV RNA in cerebrospinal fluid (CSF), but not blood plasma. Although HAART has improved immune function in many HIV1 individuals, milder neurocognitive dysfunction often persists, possibly due to poor penetration of some antiretroviral agents into the CNS. Objectives: We performed 2 studies to evaluate whether elevated CSF HIV RNA predicts subsequent NP decline (Study 1), and whether changes in incident NP impairment have occurred since the introduction of HAART (Study 2). Methods: All subjects were HIV1, rated NP normal at baseline, and part of a larger prospective, longitudinal cohort study. HAART was prescribed at the discretion of the subjects' primary care physicians. Comprehensive NP and neuromedical evaluations were performed at initial and follow-up visits, at least 6 months apart. Study 1 (N = 94) included participants at varying stages of HIV disease. Study 2 (N=46) was restricted to persons at high risk for developing NP impairment, i.e., those with CDC stage C HIV disease. Results: In Study 1, higher HIV RNA CSF at baseline predicted a higher risk of incident NP impairment at follow-up. However, plasma HIV RNA did not predict subsequent impairment. Study 2 revealed that twice as many participants (36%) in the pre-HAART group developed NP impairment than in the post-HAART group (17%), and incident NP impairment occurred significantly sooner in the pre-HAART cohort. Conclusions: Taken together, the results suggest that HIV RNA in CSF predicts incident NP impairment, while HAART protects from subsequent NP impairment. |
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