HIV suppression by HAART preserves cognitive function in advanced, immune-reconstituted AIDS patients

McCutchan, J. Allen; Wu, Julia; Robertson, Kevin; Koletar, Susan L.; Ellis, Ronald J.; Cohn, Susan E.; Taylor, Michael J.; Woods, Steven Paul; Heaton, Robert K.; Currier, Judith S.; Williams, Paige L.

doi:10.1097/qad.0b013e3280ef6acd

Cited by 70 publications

(51 citation statements)

References 32 publications

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“…9,10 With the advent of highly-active antiretroviral therapy (HAART) in the mid-to-late ’90s, 11 the neurocognitive sequelae of HIV have lessened in severity 12–14 and become somewhat more variable in expression, 15 although mild neurocognitive deficits persist. 13,16–19 Although the current cognitive impairment-profile of HIV is relatively mild for many individuals, it is nonetheless predictive of significant decline in daily functioning. 20 Also, significant variability in HAART adherence patterns among HIV+ individuals 21 may account for recent reports of variable neurocognitive expression of HIV.…”

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confidence: 99%

Antiretroviral Adherence and the Nature of HIV-Associated Verbal Memory Impairment

Wright¹,

Woo²,

Foley³

et al. 2011

Journal of Neuropsychiatry

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The authors investigated the relationship between antiretroviral adherence and HIV-associated verbal memory impairment. HIV-positive participants demonstrated poorer verbal memory than HIV-negative participants. Both good (≥90%) and poor (<90%) adherers displayed encoding deficits as compared with controls, but only poor adherers exhibited retrieval deficits. Encoding deficits primarily accounted for reduced delayed recall in good adherers, but both encoding and retrieval deficits accounted for reduced delayed recall in poor adherers. The retrieval difference between the adherence groups might be explained by a neuroprotective effect of good antiretroviral adherence or preexisting HIV-related retrieval deficits that result in poorer adherence.

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confidence: 99%

Antiretroviral Adherence and the Nature of HIV-Associated Verbal Memory Impairment

Wright¹,

Woo²,

Foley³

et al. 2011

Journal of Neuropsychiatry

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“…Mild cognitive impairment has been increasingly recognized as a common feature of chronic HIV infection, even in patients with good viral control on highly active antiretroviral therapy (HAART) [1]. It occurs in 30-50% of patients, depending on both the cohort under study and how the impairment is identified [1][2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…It occurs in 30-50% of patients, depending on both the cohort under study and how the impairment is identified [1][2][3][4][5][6][7][8]. The current diagnostic approach is descriptive: HIV-associated neurocognitive disorder (HAND) is termed 'asymptomatic neurocognitive impairment' when found on testing in the absence of symptoms, and 'mild neurocognitive disorder' when both signs and symptoms are present, but are not severe enough to constitute frank dementia [9].…”

Section: Introductionmentioning

confidence: 99%

Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment*

et al. 2011

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Existing tools for rapid cognitive assessment in HIV-positive individuals with mild cognitive deficits lack sensitivity or do not meet psychometric requirements for tracking changes in cognitive ability over time. MethodsSeventy-five nondemented HIV-positive patients were evaluated with the Montreal Cognitive Assessment (MoCA), a brief battery of standardized neuropsychological tests, and computerized tasks evaluating frontal-executive function and processing speed. Rasch analyses were applied to the MoCA data set and subsequently to the full set of data from all tests. ResultsThe MoCA was found to adequately measure cognitive ability as a single, global construct in this HIV-positive cohort, although it showed poorer precision for measuring patients of higher ability. Combining the additional tests with the MoCA resulted in a battery with better psychometric properties that also better targeted the range of abilities in this cohort. ConclusionThis application of modern test development techniques shows a path towards a quick, quantitative, global approach to cognitive assessment with promise both for initial detection and for longitudinal follow-up of cognitive impairment in patients with HIV infection. IntroductionMild cognitive impairment has been increasingly recognized as a common feature of chronic HIV infection, even in patients with good viral control on highly active antiretroviral therapy (HAART) [1]. It occurs in 30-50% of patients, depending on both the cohort under study and how the impairment is identified [1][2][3][4][5][6][7][8]. The current diagnostic approach is descriptive: HIV-associated neurocognitive disorder (HAND) is termed 'asymptomatic neurocognitive impairment' when found on testing in the absence of symptoms, and 'mild neurocognitive disorder' when both signs and symptoms are present, but are not severe enough to constitute frank dementia [9]. The underlying pathophysiology remains poorly understood [10], posing challenges in the everyday management of these mildly affected patients.How should cognitive impairment be detected in routine practice? Should those found to be affected have their HAART regimen changed, to emphasize antiretrovirals with better central nervous system penetration? Should additional therapies, such as anti-excitotoxic agents or drugs targeting neurodegenerative changes, be added to their treatment? If such changes are made, how should the effects be monitored? The answers to such questions require better tools to assess cognition in HIV-infected individuals. The ideal measure should not only establish the diagnosis, but also quantify the severity of impairment. DOI: 10.1111/j.1468-1293.2010.00910.x HIV Medicine (2011 r 2011 British HIV Association 472It should also be free, brief, easy to administer with minimal training by any health professional, and available to clinics where HIV-infected patients receive their care. The present study describes the initial steps in the development of such a method to measure cognition across the intact to mildly impaired ...

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“…The prevalence of neuropsychological impairment in this sample was 46% before transplant, three times that which would be expected in the general population. 36,54,55 Almost a third of patients were impaired at 6 months post transplant, suggesting that cognitive functioning remains a prevalent and important issue during recovery after allogeneic HCT. The trajectory and predictors of neurocognitive functioning over this time course is an important issue that will be explored (manuscript in preparation).…”

Section: Discussionmentioning

confidence: 99%

Relationship between neurocognitive functioning and medication management ability over the first 6 months following allogeneic stem cell transplantation

Mayo

Messner

Rourke

et al. 2016

Bone Marrow Transplant

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Although neurocognitive impairment has been established as a major issue among cancer survivors, the real-world consequences of this impairment are unclear. This study investigated the relationship between neurocognitive functioning and medication management ability over time among 58 patients treated with allogeneic hematopoietic stem cell transplantation (HCT). Participants completed a neuropsychological test battery and a simulated medication management task at three time points: pretransplant (T0), Day 100 (T1) and 6 months post transplant (T2). Neurocognitively impaired participants performed worse on the medication management task than neurocognitively normal participants at each time point, and were more likely to score in the impaired range of medication management ability post transplant (72% vs 20%, P o 0.001 at T1; 67% vs 23%, P = 0.013 at T2). In multivariate analyses, worse performance in executive functioning/working memory consistently predicted impaired medication management ability, even when controlling for sociodemographic and clinical confounders (odds ratio = 0.89, 95% confidence interval (0.80, 0.98), P = 0.023). Lower physical symptom distress also predicted impaired medication management ability, but this effect decreased over time. Self-reported cognitive problems were not correlated with medication management ability at any time point. Findings suggest that poor neurocognitive functioning, particularly in the domain of executive functioning/working memory, is associated with worse medication management ability within the first 6 months after allogeneic HCT.

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HIV suppression by HAART preserves cognitive function in advanced, immune-reconstituted AIDS patients

Cited by 70 publications

References 32 publications

Antiretroviral Adherence and the Nature of HIV-Associated Verbal Memory Impairment

Antiretroviral Adherence and the Nature of HIV-Associated Verbal Memory Impairment

Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment*

Relationship between neurocognitive functioning and medication management ability over the first 6 months following allogeneic stem cell transplantation

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