Does highly active antiretroviral therapy improve neurocognitive function? A systematic review

Abstract

Highly active antiretroviral therapy (HAART) reduces the incidence of human immunodeficiency virus (HIV) dementia (HAD), whereas the overall prevalence appears to have increased. Recent changes to diagnostic nosology have emphasized the presence of neurocognitive deficits. Uniform methods of ascertaining neuropsychological impairment and excluding confounding causes are critical to between-study comparison. We conducted a systematic review on all studies that use single-cohort prospective treatment effect design that reported on the neurocognitive or neuropsychological profile of individuals commencing HAART. Fifteen 15 relevant studies were included. A large number of studies using observational or cross-sectional designs were excluded, as these do not allow for a within-subject description of pre- and post-HAART predictive factors. Eleven studies reported a significant improvement in neurocognitive status or neuropsychological profile over an average study period of 6 months. Variable or nonreporting of HAART regimens in these studies did not allow for an analysis of individual agent or regimen effectiveness. The results show that although HAART does improve cognition, it does not appear to fully eradicate impairments. The methods used in this research differ widely and therefore comparison across studies is difficult. Studies examining the long-term effects of HAART on HIV-associated neurocognitive disorders (HANDs) using uniform methods of data collection are needed, together with clear reporting of HAART regimens.

HIV-associated neurocognitive disorders: Antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes

“…However, 1 year is not an unreasonable follow-up period, given that it has been shown that significant cognitive improvement is usually seen within 6 months of starting ART. [11] It could be argued that a selection bias exists in this study, in terms of excluding those participants not on suppressive ART regimens for ≥10 months. These participants may have had poorer cognitive function and therefore greater difficulty in accessing and adhering to ART.…”

“…[8][9][10] ART typically produces a significant improvement in neurocognitive status within 6 months of treatment. [11] This does not, however, imply a complete recovery in all cases. In fact, incident cases of cognitive dysfunction can still arise while patients are on suppressive ART regimens.…”

The impact of marijuana use on memory in HIV-infected patients: a comprehensive review of the HIV and marijuana literatures

“…One systematic review reported that HAART can improve cognition among HIV-infected individuals [89], but a subsequent review suggested that antiretroviral therapy did not improve memory functioning and may even have a negative impact [90]. Thus, it will be important to clarify the impact that these medications have on neurocognitive functioning in order to tease out the unique contributions of marijuana use.…”

What’s in a Name? AIDS Dementia Complex, HIV-associated Dementia, HIV-associated neurocognitive disorder or HIV Encephalopathy

“…10,13-14 As yet there are no treatment guidelines for HAD, but it is generally accepted HAART improves cognition. 15 Whilst we await recommendations on specific ARV regimes or other treatments, we should initiate patients with HAD on ARVs. Given the burden of HAND and direct benefits of starting ARVs, there is an urgency to develop rapid screening tools to detect and monitor HAND.…”