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Prevalence (59%) and Correlates of Minor Neurocognitive Disorders in Asymptomatic HIV-infected Outpatients
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Reported by Jules Levin
CROI 2010 Feb 16-19 SF
Nicoletta Ciccarelli1,2, Massimiliano Fabbiani1, Simona Di Giambenedetto1, Iuri Fanti1, Manuela Colafigli1, Laura Bracciale1, Enrica Tamburrini1, Roberto Cauda1, Andrea De Luca1,3*, Maria Caterina Silveri2
1Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy; 2Memory Clinic, Catholic University of Sacred Heart, Rome, Italy; 3Infectious Diseases Unit, Siena University Hospital, Italy.
Corresponding Author: *Dr.Andrea De Luca, Email: andrea.deluca@rm.unicatt.it, Tel. +390630154945, Fax. +39063054519.
AUTHOR CONCLUSIONS
High prevalence of minor cognitive disorders was observed in apparently asymptomatic HIV+ individuals.
Cognitive impairment was associated with lower CD4 cells count nadir and efavirenz use.
In this cross-sectional study, no association between CPE rank and cognitive impairment was observed, even after excluding patients receiving efavirenz.
Neuropsychological investigation is important in the long term management of HIV+ patients.
ABSTRACT
Background: Despite the availability of potent antiretroviral regimens (cART), minor cognitive disorders are increasingly recognized in HIV-infected patients. However, their prevalence, characteristics and clinical and treatment-related correlates need to be better investigated.
Methods: We performed a cross-sectional single cohort study, consecutively enrolling asymptomatic HIV+ subjects during routine outpatient visits. All patients underwent Mini Mental State Examination and an extensive neuropsychological battery exploring memory, attention, and executive abilities. The Zung Depression Scale was also administered. Each patient was considered cognitively impaired if he scored below the cut-off in >3 tests, on the basis of results obtained in matched healthy HIV-negative subjects. Central nervous system penetration-effectiveness (CPE) rank was calculated for each cART regimen according to CHARTER group. Factors associated with cognitive impairment were investigated by linear or logistic regression analysis.
Results: There were 136 patients enrolled, with the following characteristics: 59.6% males, median age 47 years (IQR 40 to 54), 15.4% non-Italian born, 27.2% with past AIDS-defining events, 77.2% with HIV-RNA<50 copies/mL, median CD4 cells count 509/µL (IQR 394 to 703). Overall, 119 (87.5%) subjects were on cART, 68% of whom with a stable (>1 year) regimen. CPE rank was >1.5 in 55.5% of subjects on therapy.
The overall median of pathological tests was 3 (IQR 1 to 4). Seventy patients (51.5%) were classified as cognitively impaired.
At multivariate analysis, CD4 cells count nadir (OR 0.73 per 100 cells increase, P =0.018) was significantly associated to a lower risk of cognitive impairment, while efavirenz (EFV) use was associated to increased risk (OR 5.37, P =0.004).
No association was observed between Zung Depression score and cognitive performance. Considering any single task, only performance in procedural learning was significantly predicted by EFV use (P =0.030). Higher CD4 cells count nadir was a good predictor of better performance in memory (P =0.039). In this cross-sectional study, no association between CPE rank and cognitive impairment was observed, even after excluding patients receiving EFV.
Conclusions: High prevalence of minor cognitive disorders was observed in apparently asymptomatic HIV+ individuals. Mild cognitive impairment was associated to lower nadir CD4 count and EFV use. Neuropsychological investigation is important in the long-term management of HIV+ patients.
BACKGROUND
Despite the availability of potent antiretroviral regimens (cART), minor cognitive disorders are increasingly recognized in HIV-infected patients.
The purpose of the study was to investigate prevalence, characteristics and clinical and treatment-related correlates of cognitive disorders in HIV-infected patients.
RESULTS
A total of 136 patients were enrolled. Population characteristics are summarized in Table 4.
The overall median pathological tests were 3 (IQR 1-4).
The performance in each cognitive test is shown I Table 5.
70 patients (51.5%) were classified as cognitively impaired (>/3 pathological tests). Such proportion reached 59% in patients with past AIDS-defining events (see Figure 1).
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