Publication Abstract Display
Type: Published Manuscript
Title: CD4 nadir is a predictor of HIV neurocognitive impairment in the era of combination antiretroviral therapy.
Authors: Ellis RJ, Badiee J, Vaida F, Letendre S, Heaton RK, Clifford D, Collier AC, Gelman B, McArthur J, Morgello S, McCutchan JA, Grant I, and the CHARTER Group
Year: 2011
Publication: AIDS (London, England)
Volume: 25 Issue: 14 Pages: 1747-1751
Abstract:OBJECTIVE: Despite immune recovery in individuals on combination antiretroviral therapy (CART) the frequency of HIV-associated neurocognitive disorders (HAND) remains high. Immune recovery is typically achieved after initiation of ART from the nadir, or lowest historical CD4. The present study evaluated the probability of neuropsychological impairment (NPI) and HAND as a function of nadir CD4 in an HIV+ cohort. METHODS: 1525 HIV+ participants enrolled in CHARTER, a multi-site, observational study completed comprehensive neurobehavioral and neuromedical evaluations, including a neurocognitive test battery covering 7 cognitive domains. Among impaired individuals, HAND was diagnosed if NPI could not be attributed to comorbidities. Nadir CD4 was obtained by self-report or observation. Potential modifiers of the relationship between nadir CD4 and HAND, including demographic and HIV disease characteristics were assessed in uni- and multivariate analyses. RESULTS: The median nadir CD4 (cells/mm) was 172, and 52% had NPI. Among impaired participants, 603 (75%) had HAND. Higher CD4 nadirs were associated with lower odds of NPI such that for every 5-unit increase in square-root CD4, the odds of NPI was reduced by 10%. In 589 virally suppressed participants on ART, higher nadir CD4 was associated with lower odds of NPI after adjusting for demographic and clinical factors. CONCLUSIONS: Since the risk of NPI was lowest in subjects whose CD4 was never allowed to fall to low levels before CART initiation, our findings suggest that initiation of CART as early as possible might reduce the risk of developing HAND, the most common source of NPI among HIV-infected individuals.

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