Association of Brain Structure Changes and Cognitive Function With Combination Antiretroviral Therapy in HIV-Positive Individuals

Abstract

IMPORTANCE Despite the introduction of combination antiretroviral therapy (cART), HIV-associated neurocognitive disorders continue to be a problem for treated HIV-positive individuals. The cause of this impairment remains unclear.OBJECTIVE To determine if detectable brain changes occur during a 2-year period in HIV-positive individuals who were aviremic and treated with cART. DESIGN, SETTING, AND PARTICIPANTSIn this longitudinal case-control study, participants underwent neuroimaging and neuropsychological assessment approximately 2 years apart. Data were collected from October 26, 2011, to March 1, 2016. Data from 92 HIV-positive individuals were acquired at Washington University in St Louis from ongoing studies conducted in the infectious disease clinic and AIDS Clinical Trial Unit. A total of 55 HIV-negative control participants were recruited from the St Louis community and a research participant registry. A total of 48 HIV-positive individuals who were aviremic and treated with cART and 31 demographically similar HIV-negative controls met the study requirements and were included in the analyses.MAIN OUTCOMES AND MEASURES Brain volumes were extracted with tensor-based and voxel-based morphometry and cortical modeling. Raw scores from neuropsychological tests quantified cognitive performance. Multivariable mixed-effects models assessed the effect of HIV serostatus on brain volumes and cognitive performance, and determined if HIV serostatus affected how these measures changed over time. With HIV-positive participants, linear regression models tested whether brain volumes and cognitive performance were associated with measures of infection severity and duration of infection.

Plasma HIV RNA level is associated with neurocognitive function among HIV-1-infected patients in Nigeria

“…There is a glaring need to intensify the implementation of strategies that foster early initiation of cART, retention in care and optimal adherence. Accordingly, the World Health Organization’s ‘test and treat’ policy recommendation (Camlin et al 2016) may be invaluable towards ameliorating the burden of HAND (Sanford et al 2018). This could be of paramount importance especially in resource constrained settings, where late presentation and limited access to treatment remain formidable challenges.…”

Longitudinal Trajectories of Brain Volume and Cortical Thickness in Treated and Untreated Primary Human Immunodeficiency Virus Infection

“…HIV penetrates the central nervous system (CNS) soon after initial infection [1]. Despite the use of combination antiretroviral therapy (cART), people living with HIV continue to experience cognitive impairment [1][2][3]. The etiology of this mild, but quality-of-life limiting brain dysfunction is unclear.…”

“…Recently, longitudinal studies demonstrated that well-treated, aviremic chronic HIV-infected (CHI; defined as >1 year after exposure) individuals had significant brain volume reductions compared to controls at all visits, but changes in brain volume over time were similar in both groups [3,4]. Although these results argue against an active, destructive process to be the cause of the brain alterations, the timing of these changes remain uncertain.…”

Absence of peripapillary retinal nerve-fiber–layer thinning in combined antiretroviral therapy-treated, well-sustained aviremic persons living with HIV

“…Indeed, the CASCADE study showed that PLHIVs are mostly diagnosed and treated with a CD4+ T-cell count nadir >200 cells/μL [57]. Recent findings showed that full viral suppression may preserve long-term PLHIVs' brain health [58]. Hence, continuing to report results concerning virologically uncontrolled, cART-treated PLHIVs is not really suitable [54,55,58].…”