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

Abstract

Background. The human immunodeficiency virus (HIV) can give rise to a spectrum of neuropsychological impairments known collectively as HIV-associated neurocognitive disorders (HAND). Although antiretroviral therapy (ART) has reduced the incidence of HIV dementia, the prevalence of milder forms of HAND has increased. It has been postulated that incomplete central nervous system (CNS) viral suppression or potential drug toxicity, both of which could be related to the CNS penetration effectiveness (CPE) of ART regimens, may contribute to this phenomenon. Objective. This study compared cognitive outcomes in clade C-infected HIV patients in South Africa treated for 1 year with ART regimens with differing CPE scores. Methods. We assessed 111 HIV-positive patients with varying levels of cognitive function at baseline (pre-ART) and then a year later. A neuropsychological battery was administered at both visits to derive global deficit scores. ART regimen data were collected at the follow-up visit. Some participants remained ART-naïve during this period, thus providing a non-treatment control group. Results. Significantly more ART recipients maintained or improved cognitive function compared with patients not on ART (p=0.017). There was no significant difference in cognitive outcomes between higher and lower CPE regimen groups (p=0.473). Conclusions. ART preserves or improves cognition in HIV-infected patients after 1 year, irrespective of the regimen's CPE. South Africa's current low CPE-scored first-line regimen performed as well as higher CPE-scored regimens. These findings are reassuring for South Africa, but larger, longer-term studies would be more definitive.

Role of Magnetic Resonance Imaging in Evaluation of the Brain Lesions in HIV-infected Patients: A Prospective Observational Study

“…14,15 Moreover, observations from Guevara-Silva, Sacktor et al and Cross et al showed significant improvement in cognitive impairment after antiretroviral therapy in HIVinfected patients. [16][17][18] Functional alterations of the neurons by immunological and inflammatory changes due to HIVinfection may have role in the cognitive impairment. [19][20][21] Majority of the lesions observed in T1-weighted MRI was hypointense (70.6%).…”

Clinico-Immunological Status and Neurocognitive Function of Perinatally Acquired HIV-Positive Children on cART: A Cross-Sectional Correlational Study in South Africa

“…It goes without saying that advances made in antiretroviral treatment have transformed the disease into a chronic but manageable illness that enabled children to live longer with HIV. Although early initiation of cART has resulted in great improvements in survival, neurological consequences remain an important comorbidity among children living with HIV (7). The neuropathogenesis of HIV-associated neurocognitive disorder in the era of cART is complex and among others includes persistent systematic and central nervous system inflammation, oxidative stress, and HIV-subtype (clade) neurovirulence variation, associated with neuronal death and potential neurotoxicity of cART drugs (8).…”

The effects of antiretroviral treatment initiation on cognition in HIV-infected individuals with advanced disease in Pune, India

“…In a later report, using a more comprehensive neuropsychological battery 76% of untreated HIV patients were classified as impaired (Joska et al 2011). A recent study of ART naïve HIV+ patients in South Africa (Cross et al 2013) found significant preservation or improvement in cognition following ART initiation, although the study was limited by the small number of participants available to adjust for practice effects.…”