Long-Term Neurologic Exam Findings in People Diagnosed and Treated During Acute HIV Infection

Evaluate clinical and laboratory correlates of abnormal neurologic exam findings after acute HIV infection (AHI).

Participants from the RV254/SEARCH 010 cohort in Bangkok underwent standardized neurologic examinations at Weeks 0 (AHI), 12, 96, and 288 following antiretroviral therapy (ART). A subset of participants completed 3T neuroimaging. Associations between neuroimaging, clinical and HIV parameters, and abnormal neurologic exam were analyzed using chi-square tests and multinomial regression.

At AHI, 703 participants (median age 26.5 years, 97.6% male) had neurologic exams, with follow-up data available for 493, 667, and 560 participants at Weeks 12, 96, and 288, respectively. Viral suppression (≤ 50 copies/mL) was 0% at Week 0, 65% at Week 12, 98% at Week 96, and 99% at Week 288. Abnormalities in any neurologic exam domain were observed in 26%, 28%, 17%, and 8% of participants at each time point. Most findings occurred in sensory and fine motor domains. During AHI, history of HCV co-infection associated with abnormal exam (p = 0.006). At Weeks 96 and 288, higher CD4:CD8 ratio correlated with abnormal exam at the same visit (p = 0.040 Week 96, p = 0.018 Week 288). In a longitudinal model, higher Fiebig stage associated with conversion from abnormal to normal neurologic exam (p < 0.035). Of participants with MRIs, 14% at Week 0 and 36% at Week 96 demonstrated abnormalities; abnormal MRI at Week 0 associated with abnormal fine motor performance (p = 0.045).

Objective neurologic abnormalities are common during AHI, though few persist with long-term ART. Coinfections, immunologic state, and demographic factors modify these outcomes.