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Abstract
Objective: While HIV-associated neurocognitive disorders (HAND) remain prevalent despite combination antiretroviral therapy (CART), the clinical relevance of asymptomatic neurocognitive impairment (ANI), the most common HAND diagnosis, remains unclear. We investigated whether HIV-infected persons with ANI were more likely than those who were neurocognitively normal (NCN) to experience a decline in everyday functioning (symptomatic decline).
Methods: A total of 347 human participants from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) cohort were NCN (n = 226) or had ANI (n = 121) at baseline. Neurocognitive assessments occurred approximately every 6 months, with median (interquartile range) follow-up of 45.2 (28.7–63.7) months. Symptomatic decline was based on self-report (SR) or objective, performance-based (PB) problems in everyday functioning. Proportional hazards modeling was used to generate risk ratios for progression to symptomatic HAND after adjusting for baseline and time-dependent covariates, including CD4+ T-lymphocyte count (CD4), virologic suppression, CART, and mood.
Results: The ANI group had a shorter time to symptomatic HAND than the NCN after adjusting for baseline predictors: adjusted risk ratios for symptomatic HAND were 2.0 (confidence interval [CI] 1.1–3.6; p = 0.02) for SR, 5.8 (CI 3.2–10.7; p < 0.0001) for PB, and 3.2 (CI 2.0–5.0; p < 0.0001) for either SR or PB. Current CD4 and depression were significant time-dependent covariates, but antiretroviral regimen, virologic suppression, and substance abuse or dependence were not.
Conclusions: This longitudinal study demonstrates that ANI conveys a 2-fold to 6-fold increase in risk for earlier development of symptomatic HAND, supporting the prognostic value of the ANI diagnosis in clinical settings. Identifying those at highest risk for symptomatic decline may offer an opportunity to modify treatment to delay progression.
GLOSSARY
- ANI=
- asymptomatic neurocognitive impairment;
- ART=
- antiretroviral therapy;
- BDI=
- Beck Depression Inventory–II;
- CART=
- combination antiretroviral therapy;
- CHARTER=
- CNS HIV Anti-Retroviral Therapy Effects Research;
- CI=
- confidence interval;
- HAD=
- HIV-associated dementia;
- HAND=
- HIV-associated neurocognitive disorders;
- HCV=
- hepatitis C virus;
- IADL=
- instrumental activities of daily living;
- MMT-R=
- revised version of the Medication Management Test;
- MND=
- mild neurocognitive disorder;
- NCN=
- neurocognitively normal;
- NNRTI=
- non-nucleoside reverse transcriptase inhibitor;
- PAOFI=
- Patient's Assessment of Own Functioning Inventory;
- PB=
- performance-based;
- PI=
- protease inhibitor;
- SR=
- self-report
Footnotes
Coinvestigators are listed on the Neurology® Web site at Neurology.org.
The views expressed in this article are those of the authors and do not reflect the official policy or position of the United States Government.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 2046
Supplemental data at Neurology.org
- Received October 29, 2013.
- Accepted in final form February 13, 2014.
- © 2014 American Academy of Neurology
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