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Neuropsychological Performance in Acute HIV
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Determinants of Baseline Performance and Effects of
Immediate Antiretroviral Therapy
I. Kore1, J. Ananworanich2,3,4, V. Valcour5, J. Fletcher2, D. Suttichom2, P.
Mangum2, L. Jagodzinski6, J. Kim6, S. Spudich1, and RV254/SEARCH 010
Study Group
1Yale University, New Haven, CT; 2SEARCH, Bangkok, Thailand; 3HIV-NAT, Bangkok, Thailand; 4Chulalongkorn University,
Bangkok, Thailand; 5University of California, San Francisco, CA; 6US Military HIV Research Program, Silver Spring, MD
from jules: in this study conducted in Thailand in acute HIV-infection 22% of HIV-infected performed less well in neurologic psychological testing compared to HIV-neg controls, although overall the investigators said performance was not different. Neurological performance was correlated with CSF viral load, so higher CSF viral load correlated with worse performance (CD4 appeared to have perhaps a protective affect), which you would expect & supports the notion that HAAT & early HAART would improve performance. In fact they reported here HAART improved performance after 6 months but interestingly Mega HAART didnt improve performance any greater than standard HAART.
Study Conclusions
· Neuropsychological performance inversely correlated with CSF HIV RNA and days post HIV transmission.
· No correlation between neuropsychological performance and depression/anxiety scores.
· CD4 - possible protective factor, moderates association between CSF HIV RNA and neuropsychological performance.
· Only one processing speed test (Color Trails 1) had greater improvement than HIV-uninfected controls.
· Mega-HAART was not associated with greater neuropsychological improvement vs. standard HAART.
link to webcast:
http://webcasts.retroconference.org/console/player/19408?mediaType=podiumVideo
Background
· Despite antiretroviral therapy, some individuals with chronic HIV infection still manifest mild neurocognitive impairment.
· Is neurocognitive impairment present in the acute stages of HIV infection?
· Are there disease markers that correlate with impairment on neuropsychological testing?
· Does immediate antiretroviral therapy associate with improved neuropsychological performance in follow up?
Methods
· In a unique cohort of subjects identified during acute HIV infection by nucleic acid testing in Bangkok, we:
- Investigated baseline predictors of neuropsychological
performance
· Days post HIV transmission, CD4 count, CD8 count, CSF HIV RNA, plasma HIV RNA, CSF WBC, CSF protein
- Evaluated effect of immediate antiretroviral therapy on
longitudinal neuropsychological performance
· HAART = Tenofovir, Emtricitabine, Efavirenz
· Mega-HAART = HAART + Raltegravir, Maraviroc
RESULTS
At baseline, 22% (N = 8) performed >1 SD below norm means on ³2 NP tests, but overall the acute group performed normally, there was no significant difference between HIV+ and uninfected controls (see slide)
NP performance was negatively correlated with cerebrospinal fluid (CSF) viral load (r = -0.493, p = 0.023) and days post-transmission (r = -0.389, p = 0.019). (see slide), as CSF viral load got greater they performed less well on the neurological psychological tests. CD4 appears to play a buffering role in the relationship between CSF viral load & performance testing (see slide).
Since patients had recently received their HIV diagnosis investigators wanted to see if this affected their performance on tests,
NPZ4 scores did not correlate with depression (p = 0.336) or anxiety measures (p = 0.861).
After starting HAART there was a significant improvement between week 0 and week 12 in processing speed and executive function but no change in motor.
To see if this improvement was real they compared performance of HIV+ to HIV-neg controls, and they reported: only color trails 1 had greater change from baseline than HIV-uninfected controls at week 24 (see Slide).
After 6 months on HAART, comparing HAART & Mega HAART they found similar longitudinal improvements in all domains between standard & Mega HAART.
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