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Treatment initiation factors and cognitive outcome in youth with perinatally acquired HIV infection

J Rutstein Lazarus1,2, R M Rutstein2,3, E D Lowenthal2,3

  • 1Institute for Graduate Clinical Psychology, Widener University, Chester, PA, USA.

HIV Medicine
|January 22, 2015
PubMed

Insights

Starting highly active antiretroviral therapy (HAART) before AIDS diagnosis significantly improved cognitive outcomes in youth with perinatal HIV. Early HAART initiation or high central nervous system (CNS) penetration effectiveness did not impact cognitive scores.

Area of Science:

  • Pediatric infectious diseases
  • Neuropsychology
  • HIV/AIDS research

Background:

  • Highly active antiretroviral therapy (HAART) has improved cognitive outcomes in youth with perinatal HIV.
  • The influence of HAART initiation age and regimen central nervous system (CNS) penetration effectiveness (CPE) on cognitive function remains unclear.

Purpose of the Study:

  • To investigate the association between the age of HAART initiation, the CPE of the antiretroviral regimen, and cognitive outcomes in perinatally HIV-infected youth.
  • To determine if initiating HAART before an AIDS diagnosis impacts cognitive function.

Main Methods:

  • Retrospective analysis of cognitive outcomes (Full-Scale IQ score - FSIQ) in a US cohort of perinatally HIV-infected youth.
  • Linear regression was used to assess the relationship between FSIQ, HAART initiation age, regimen CPE, and prior AIDS diagnosis.

Main Results:

  • Neither the age of HAART initiation nor the CPE score was significantly associated with FSIQ.
  • Patients initiating HAART before an AIDS diagnosis had a significantly higher mean FSIQ (90) compared to those diagnosed with AIDS before HAART initiation (82).
  • Initiating HAART before age 5 significantly reduced the risk of developing AIDS (RR=0.19).

Conclusions:

  • Initiating HAART earlier or using regimens with higher CPE did not enhance cognitive outcomes in this cohort.
  • Starting HAART before the onset of AIDS is crucial for preventing AIDS progression and is associated with better cognitive function (higher FSIQ).
Abstract

Keywords:
HIV infectionantiretroviral therapycentral nervous system penetration effectivenesscognitive outcome

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