Low prevalence of neurocognitive impairment in early diagnosed and managed HIV-infected persons

• Published in: Neurology Vol. 80; no. 4; pp. 371 - 379
• Main Authors: CRUM-CIANFLONE, Nancy F, MOORE, David J, HALE, Braden R, LETENDRE, Scott, POEHLMAN ROEDIGER, Mollie, EBERLY, Lynn, WEINTROB, Amy, GANESAN, Anuradha, JOHNSON, Erica, DEL ROSARIO, Raechel, AGAN, Brian K
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 22-01-2013
• Subjects: Adolescent; Adult; Age; AIDS Dementia Complex - diagnosis; AIDS Dementia Complex - drug therapy; AIDS Dementia Complex - epidemiology; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active - statistics & numerical data; Biological and medical sciences; CD4 antigen; CD4 Lymphocyte Count - statistics & numerical data; Cognition; Cognition Disorders - diagnosis; Cognition Disorders - epidemiology; Cognition Disorders - virology; Comorbidity; Cross-Sectional Studies; Early Diagnosis; Female; highly active antiretroviral therapy; Human immunodeficiency virus; Human viral diseases; Humans; Infection; Infectious diseases; Male; Medical sciences; Middle Aged; Military Personnel - statistics & numerical data; Neurology; Neuropsychological Tests; Prevalence; Risk Factors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult; Infection; Immunopathology; Nervous system diseases; Prevalence; Cognitive disorder; Viral disease; AIDS; Immune deficiency
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0b013e31827f0776

To describe the prevalence of neurocognitive impairment (NCI) among early diagnosed and managed HIV-infected persons (HIV+) compared to HIV-negative controls.
We performed a cross-sectional study among 200 HIV+ and 50 matched HIV-uninfected (HIV-) military beneficiaries. HIV+ patients were categorized as earlier (<6 years of HIV, no AIDS-defining conditions, and CD4 nadir >200 cells/mm(3)) or later stage patients (n = 100 in each group); both groups were diagnosed early and had access to care. NCI was diagnosed using a comprehensive battery of standardized neuropsychological tests.
HIV+ patients had a median age of 36 years, 91% were seroconverters (median window of 1.2 years), had a median duration of HIV of 5 years, had a CD4 nadir of 319, had current CD4 of 546 cells/mm(3), and 64% were on highly active antiretroviral therapy (initiated 1.3 years after diagnosis at a median CD4 of 333 cells/mm(3)). NCI was diagnosed among 38 (19%, 95% confidence interval 14%-25%) HIV+ patients, with a similar prevalence of NCI among earlier and later stage patients (18% vs 20%, p = 0.72). The prevalence of NCI among HIV+ patients was similar to HIV- patients.
HIV+ patients diagnosed and managed early during the course of HIV infection had a low prevalence of NCI, comparable to matched HIV-uninfected persons. Early recognition and management of HIV infection may be important in limiting neurocognitive impairment.