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More Than Half of Adult Group With Perinatal HIV Have Neurocognitive Impairment
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17th European AIDS Conference, November 6-9, 2019, Basel
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Mark Mascolini
In a small study of young adults with perinatally acquired HIV infection and high CD4 counts, 55% had neurocognitive impairment, including 45% with HIV-associated dementia [1]. The most frequently affected cognitive domains were long-term memory, verbal fluency, and processing speed.
Neurocognitive impairment remains prevalent in people aging with HIV infection. But little is known about the impact of perinatal HIV infection on cognitive health in people who have reached young adulthood. To address that issue, researchers at the University of Alicante and collaborators at other centers conducted this observational, cross-sectional study of their perinatally infected population.
Participants had to be older than 18 after perinatal HIV acquisition. The researchers defined neurocognitive impairment by standard Frascati criteria. Participants underwent neurocognitive testing of 7 domains: attention and working memory, processing speed, long-term memory, learning, executive function, verbal fluency, and motor functioning. In participants who agreed, researchers used MRI to assess damaged brain areas. They used diffusion tensor imaging to assess microstructural changes or differences with neuropathology [2].
The analysis focused on 11 of 15 people in the perinatal HIV cohort. Age averaged 23.9 years (+/- 3) and 8 participants (73%) were men. Everyone was taking antiretroviral therapy, 6 people (54.5%) had a previous AIDS diagnosis, 6 had an undetectable viral load, and CD4 count averaged 865.
By Frascati criteria, 6 people (54.5%) had neurocognitive impairment, including 5 cases of HIV-associated dementia and 1 asymptomatic neurocognitive impairment. Of the 6 people with neurocognitive impairment, 3 had HIV encephalopathy, 2 Burkitt's lymphoma, and 1 HIV myelopathy. Neurocognitive testing determined that the most impaired domains were long-term memory, verbal fluency, and processing speed.
Nine of 11 people agreed to MRI. Diffusion tensor imaging indicated abnormalities in all 9, including abnormalities of the inferior longitudinal fasciculus in 7, corpus callosum in 6, inferior fronto-occipital fasciculus in 4, corticospinal tracts in 4, cingulum in 2, and uncinate fasciculus in 1.
The researchers noted that long-term neuropsychological outcomes in adults with perinatally acquired HIV remain unknown.
References
1. Portilla-Tamarit I, García-Rodriguez G, Bernabeu-Sanz A, et al. High prevalence of neurocognitive impairment in adults with perinatally acquired HIV infection. 17th European AIDS Conference, November 6-9, 2019, Basel. Abstract PE9/57.
2. Alexander AL, Lee JE, Mariana Lazar M, Field AS. Diffusion tensor imaging of the brain.
Neurotherapeutics. 2007; 4:316-329.
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