Neuropsychological deficits in HIV-infected patients
persist despite long-term highly active antiretroviral therapy (HAART),
according to a report in the June 1st Journal of Acquired Immune
Deficiency Syndromes.
"Our research indicates that the subgroup of patients with the
'hardest to treat' neurocognitive impairment condition is the one with
the most severe neurocognitive impairment at HAART initiation," Dr.
Valerio Tozzi from National Institute for Infectious Diseases IRCCS
Lazzaro Spallanzani, Rome, told Reuters Health. "HAART improves
neurocognitive functioning but, in our experience, the greater is the
impairment, the lower is the probability of its full reversal."
Dr. Tozzi and colleagues studied 94 HIV-infected patients. During
mean follow-up of 63 months, only 37.2% of patients had reversible
neuropsychological deficits, the authors report, and the 65-month
probability of showing persistent deficits despite HAART was 53.0%.
Persistent neuropsychological deficits were associated with lower
education level and higher prevalence of hepatitis C virus-positive
serology, the results indicate, but not with CDC stage, baseline CD4
cell count or viral load, virologic response to HAART, or changes in
CD4 cell count or viral load during HAART.
Patients with persistent neuropsychological deficits performed worse
on the composite concentration and speed of mental processing z score
and on the composite memory z score, the researchers note.
The 65-month probability of persistent deficits was higher in
patients with composite NPZ8 scores below the median (87%) than above
the median (30%), the report indicates.
In a multivariable Cox model, poor performance on the baseline
composite NPZ8 global score was the strongest predictor of persistent
neuropsychological deficits, with each one-point decrease tripling the
probability of remaining impaired despite long-term HAART.
"We believe that HAART should be started as soon as HIV-related
neurocognitive impairment is diagnosed, even in patients with 'high'
CD4 cell counts, to stop, as soon as possible, the neurological
damage," Dr. Tozzi said. "For patients that are not responding
neurologically, the presence of other potentially confounding and
treatable conditions that could affect cognition (depression, alcohol
or other substance abuse, HIV-related CNS diseases, HCV co-infection)
should be re-evaluated."
J Acquir Immune Defic Syndr 2007;45:174-182
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