HIV-associated cognitive impairment before and after the advent of combination therapy

Abstract

The objective of this study was to describe the occurrence of HIV dementia and neuropsychological testing abnormalities in a new cohort of HIV-seropositive individuals at high risk for HIV dementia and to compare these results to a cohort before the advent of highly active antiretroviral therapy (HAART). HAART has been associated with improvements in cognitive performance in some HIV-infected patients. However, it is uncertain whether HAART has changed the frequency of specific neurocognitive abnormalities. Baseline data from 272 HIV-seropositive subjects in the Dana cohort recruited from January, 1994, to December, 1995, and 251 HIV-seropositive subjects in the Northeastern AIDS Dementia Consortium (NEAD) cohort recruited from April, 1998, to August, 1999, were compared. Participants in both cohorts received nearly identical assessments. After adjusting for differences in age, education, gender, race, and CD4 count between the two cohorts, there were no differences in the occurrence of HIV dementia or abnormalities either 1 SD or 2 SDs below established norms for any of the neuropsychological tests. Even though HAART has reduced the incidence of HIV dementia, HIV-associated cognitive impairment continues to be a major clinical problem among individuals with advanced infection.

The Role of Medical Imaging in Defining CNS Abnormalities Associated with HIV-Infection and Opportunistic Infections

“…Clinical markers of disease evolution and progression are therefore essential for examining host and viral variables that might affect disease progression and or treatment efficacy. These questions are particularly important in the current era of combination antiretroviral therapies where there has been a reduction in the number of patients who experience significant cognitive symptoms (i.e., HIV-associated dementia) but an increase in the incidence of mild and moderate cognitive symptoms [1][2][3]. These studies clearly demonstrate the continued involvement of the CNS even in the context of stable disease.…”

In vivo 1H MRS of brain injury and repair during acute SIV infection in the macaque model of neuroAIDS

“…6 support the proposition that brain inflammation follows and is directly related to viremia. These findings may help to explain the reduction in incidence of HIV-associated dementia in the era of HAART despite the inability of most of those drugs to effectively enter the CNS (37).…”

Protection against Human Immunodeficiency Virus Type 1 Tat Neurotoxicity by Ginkgo biloba Extract EGb 761 Involving Glial Fibrillary Acidic Protein

“…With increased life expectancy, the prevalence of HIV-associated cognitive and neurological impairment is actually rising despite highly active antiretroviral therapy. 5,6 A number of therapeutic agents have been tried to target pathological sequelae of HIV neurological infection, ranging from the pain associated with peripheral neuropathology to neuron dysfunction and death, but few have been approved for clinical use. Thus, it is necessary to explore alternative strategies for treating HIV-associated neurological diseases.…”