The incidence of and risk factors for HIV-associated cognitive–motor complex among patients on HAART

Abstract Background While highly active antiretroviral therapy (HAART) allows for the considerable decline in the incidence of HIV-related opportunistic infections and tumors, its effect on treating HIV infection of the brain, such as HIV-associated dementias (HADs), remains unclear. Methods A cross...

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Published in:	Biomedicine & pharmacotherapy Vol. 63; no. 8; pp. 561 - 565
Main Authors:	Jevtović, Dj, Vanovac, V, Veselinović, M, Salemović, D, Ranin, J, Stefanova, E
Format:	Journal Article
Language:	English
Published:	Paris Elsevier SAS 01-09-2009 Elsevier
Subjects:	Adolescent Adult Age Factors Aged AIDS Dementia Complex - immunology AIDS Dementia Complex - physiopathology AIDS Dementia Complex - prevention & control AIDS Dementia Complex - psychology AIDS Dementia Complex - virology Anti-HIV Agents - therapeutic use Antiretroviral Therapy, Highly Active Biological and medical sciences CD4 Lymphocyte Count Cognition - drug effects Cognitive/motor complex Cross-Sectional Studies Female HAART HIV HIV - genetics HIV Infections - drug therapy HIV Infections - immunology HIV Infections - virology Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Incidence Infectious diseases Internal Medicine Logistic Models Male Medical Education Medical sciences Middle Aged Motor Skills - drug effects Neurologic Examination Neuroprotective Agents - therapeutic use Odds Ratio Pharmacology. Drug treatments Psychiatric Status Rating Scales Risk Assessment Risk Factors RNA, Viral - blood Serbia Time Factors Treatment Outcome Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Viral Load Young Adult Serbia HIV Cognitive/motor complex HAART Human Immunopathology Retroviridae AIDS Cognition Immune deficiency Lentivirus Epidemiology Incidence Infection Virus Chemotherapy Treatment Viral disease Risk factor Antiviral Human immunodeficiency virus
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Summary:	Abstract Background While highly active antiretroviral therapy (HAART) allows for the considerable decline in the incidence of HIV-related opportunistic infections and tumors, its effect on treating HIV infection of the brain, such as HIV-associated dementias (HADs), remains unclear. Methods A cross-sectional study of consecutive series of 96 patients from the Serbian HIV/AIDS cohort, treated with HAART in our HIV unit was performed to evaluate the incidence of and risk factors for cognitive/motor complex during HAART. CD4 + T cell counts and pVL values at the time of neurological evaluation were parameters of the response to HAART. The mini-mental test and neurologic examination were performed at one point of time during treatment to reveal cognitive and/or motor disorders. Results After mean HAART duration of 47 months, unimpaired cognition, minor cognitive impairment, and HIV-associated dementia were recorded in 56 (58.3%), 27 (28.1%), and 13 (13.5%), respectively. Motor abnormalities had 39 (40.6%) patients. Of these, 21, 12, and 6 patients belong to the subgroups with normal cognition, minor cognitive impairment and HAD patients, respectively. Factors predictive for HAD were age over 40 (OR 3.7, 95% CI 1.07–13.28, P = 0.039), and AIDS diagnosis prior to HAART initiation (OR 14.19, 95% CI 1.76–114.16, P = 0.013). Conversely, factors shown to be protective against HAD were the usage of AZT and NNRTIs, as components of HAART regimens (OR 0.18, 95% CI 0.046–0.76, P = 0.019, and OR 0.14, 95% CI 0.034–0.6, P = 0.008). Conclusion Cognitive/motor complex has still remained a significant neuropathology among late presenters and elder HIV/AIDS patients. Certain HAART regimens containing AZT, and/or NNRTIs, could be protective for these patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0753-3322 1950-6007
DOI:	10.1016/j.biopha.2008.09.015