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Starting Antiretrovirals Later May Hurt Cognitive Function
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Mark Mascolini
February 25, 2007
14th Conference on Retroviruses and Opportunistic Infections
Los Angeles
Top clinical researchers such as Diane Havlir (University of California, San Francisco) have long voiced worries that starting antiretroviral therapy too late may open the door to neurocognitive problems not readily reversed when therapy begins. Research unveiled at the 14th Conference on Retroviruses lends some credence to those concerns, though the results must be considered highly preliminary [1].
Jose Munoz-Moreno and coworkers at Germans Trias i Pujol Hospital in Barcelona offered a snapshot view of neurologic impairment in people starting their first antiretrovirals above or below certain CD4-cell cutoffs. They measured neurocognitive function with a battery of tests in people who began treatment with CD4 counts above or below 200, 250, 300, or 350. The tests measured attention/working memory, executive function, information processing speed, verbal memory learning, verbal fluency, and motor function. The study excluded anyone who reported drug abuse, psychiatric treatment, or a neurologic disorder.
At the three lower CD4s cutoffs studied, a higher proportion of people beginning therapy at a lower CD4 nadir had evidence of neurocognitive impairment. While 53% of 38 people starting with more than 200 CD4s had impaired neurocognitive function, 73% of 26 people starting with fewer than 200 CD4s had evidence of such problems. Respective percentages with neurocognitive impairment were 53% versus 67% for more versus fewer than 250 CD4s, and 57% versus 64% for more versus fewer than 300 CD4s.
None of these CD4-based differences reached statistical significance. But separate neurocognitive tests showed significantly worse attention/working memory among people starting with fewer than 200 CD4s (P < 0.05) and significantly worse executive function for those who began therapy with a sub-200 count (P < 0.05). These and other individual test results did not vary significantly when the Barcelona team compared people above or below CD4 cutoffs of 250, 300, or 350 cells.
Munoz-Moreno and colleagues think their results "confirm that the nadir CD4 cell count is a potential risk factor for HIV-related neurocognitive impairment." Further research could track larger groups over time after they start antiretrovirals, instead of at a single point, as in this study. Still, the conference scientific committee found the results compelling enough to include this study in a poster discussion session.
Reference
1. Munoz-Moreno J, Rodriguez C, Prats A, et al. Recommended earlier initiation of ART based on nadir CD4 cell count as a risk factor for HIV-related neurocognitive impairment. 14th Conference on Retroviruses and Opportunistic Infections. February 25-28, 2007. Los Angeles. Abstract 383.
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