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

• 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
• DOI: 10.1016/j.biopha.2008.09.015
• EISSN: 1950-6007
• ISSN: 0753-3322

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.