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Cognitive Impairment Rate Rising in HIV+ Without AIDS: CHARTER
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XVIII International AIDS Conference, July 18-23, 2010, Vienna
Mark Mascolini
Prevalence of neurocognitive impairment among HIV-infected people without AIDS is climbing in the current treatment era, according to results of a 1793-person analysis by the CHARTER cohort group [1]. The CHARTER team suggested that "longer survival on combination antiretroviral therapy [CART] may allow continued brain damage from undetected HIV replication, chronic inflammation or immune-mediated degeneration of the central nervous system ."
The study involved 857 people from the pre-CART era (1990-1995), 179 without HIV infection, 516 with HIV but without AIDS, and 162 with AIDS. The investigators compared them with 936 people from the CART era (2000-2007), 94 without HIV, 336 with HIV but without AIDS, and 506 with AIDS. All study participants received comprehensive neuromedical and neuropsychological evaluations. The analysis excluded people with other conditions that may cause neurocognitive impairment independently of HIV infection.
Average ages of people without HIV, with CDC stage A (HIV+, no AIDS), CDC stage B, and CDC stage C were similar in the pre-CART era (33.1, 31.6, 33.7, and 37.4). But in the CART era all three HIV groups were older than the HIV-negative group (34.8, 40.6, 43.3, and 44.3). Education was similar in all four groups in both treatment eras. In the CART era, current median CD4 counts were higher in the CDC-A group (466) and the CDC-B group (437) than in the CDC-C group (346).
The proportion of people with neurocognitive impairment did not change significantly from the pre-CART to the CART period in people without HIV (19% pre-CART, 16% CART) or in people with AIDS (48% pre-CART, 43% CART). But the proportion with neurocognitive impairment rose significantly in the HIV-positive non-AIDS group (29% pre-CART, 36% CART, P < 0.05).
The investigators confirmed this breakdown when they divided the cohort into four groups: HIV-negative (19% pre-CART, 16% CART), CDC-A (29% pre-CART, 36% CART, P < 0.001), CDC-B (42% pre-CART, 40% CART), and CDC-C (52% pre-CART, 45% CART). In all people with HIV, the investigators recorded significant declines from the pre-CART era to the CART era in verbal scores, SIP, and motor scores, but significant improvement in learning scores and executive decision making.
Noting that reasons for the observed changes in neurocognitive impairment in the AIDS-free HIV-positive group remain unknown, the CHARTER researchers suggested that these patterns "would be consistent with some shift to relatively greater cortical involvement." They proposed that neuroimaging and neuropathological studies should explore this possibility.
Reference
1. Heaton R, Franklin D, Ellis R, et al. Increased prevalence of HIV neurocognitive impairment among non-AIDS cases in the post-CART versus pre-CART era. XVIII International AIDS Conference. July 18-23, 2010. Vienna. Abstract THPDB106.
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