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Asymptomatic HIV-associated neurocognitive impairment increases risk for symptomatic decline
Igor Grant1, Donald R Franklin2, Reena Deutsch2
1From the University of California (I.G., D.R.F., R.D., S.P.W., F.V., R.J.E., S.L.L., T.D.M., J.H.A., J.A.M., I.A., A.G., C.F.-N., D.M.S., R.K.H.), San Diego; the University of Washington (A.C.C., C.M.M.), Seattle; Washington University (D.B.C.), St. Louis, MO; University of Texas Medical Branch (B.B.G.), Galveston; Johns Hopkins University (J.C.M.), Baltimore, MD; and The Icahn School of Medicine at Mount Sinai (S.M., D.M.S.), New York, NY. igrant@ucsd.edu.
Neurology
|May 13, 2014
Summary
Asymptomatic neurocognitive impairment (ANI) in HIV patients significantly increases the risk of developing symptomatic HAND. Early identification of ANI can help modify treatment to delay functional decline in HIV-associated neurocognitive disorders.
Area of Science:
- Neuroscience
- Infectious Diseases
- Public Health
Background:
- HIV-associated neurocognitive disorders (HAND) persist despite combination antiretroviral therapy (CART).
- Asymptomatic neurocognitive impairment (ANI) is the most common HAND diagnosis, but its clinical significance is unclear.
- Understanding ANI's impact on daily functioning is crucial for managing HAND.
Purpose of the Study:
- To determine if HIV-infected individuals with ANI are more prone to functional decline compared to neurocognitively normal (NCN) individuals.
- To investigate the prognostic value of ANI in predicting symptomatic HAND progression.
- To identify risk factors associated with the development of symptomatic decline in HAND.
Main Methods:
- Longitudinal study of 347 participants from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) cohort.
- Categorization into NCN (n=226) and ANI (n=121) groups with regular neurocognitive assessments over a median follow-up of 45.2 months.
- Symptomatic decline assessed via self-report (SR) or performance-based (PB) measures; proportional hazards modeling used for risk analysis, adjusting for CD4 count, virologic suppression, CART, and mood.
Main Results:
- The ANI group exhibited a significantly shorter time to symptomatic HAND compared to the NCN group.
- Adjusted risk ratios for symptomatic HAND were 2.0 for SR, 5.8 for PB, and 3.2 for either SR or PB.
- Current CD4 count and depression were significant predictors of progression, while CART, virologic suppression, and substance abuse were not.
Conclusions:
- Asymptomatic neurocognitive impairment (ANI) increases the risk of symptomatic HAND by 2-fold to 6-fold, confirming its prognostic value.
- Identifying individuals with ANI is critical for clinical management of HAND.
- Early detection of ANI allows for potential treatment modifications to delay functional decline and progression to symptomatic HAND.
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