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Not Taking Antiretrovirals Linked to 60% Higher Risk of Neurocognitive Decline in US
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19th Conference on Retroviruses and Opportunistic Infections, March 5-8, 2012, Seattle
Mark Mascolini
Almost one quarter of 436 HIV-positive people in the US CHARTER cohort lost ground on neuropsychological testing scales during 18 to 42 months of follow-up [1]. Being off antiretroviral therapy (ART) independently raised the risk of neurocognitive decline 60%, while having another condition that affects neuropsychological performance more than doubled the risk.
An estimated 30% to 50% of HIV-positive people have some degree of HIV-associated neurocognitive disorder (HAND), despite ready access to ART, according to CHARTER investigators. Because neuropsychological performance can change over time--for better or worse--and because current longitudinal studies last only 6 to 12 months, researchers planned this analysis of CHARTER members monitored for 18 to 42 months.
The study involved 436 CHARTER participants with at least four study visits at least 6 months apart and including comprehensive lab, neuromedical, and neuropsychological tests. The researchers used regression-based norms for neuropsychological change to chart cognitive decline.
Over the course of follow-up, 98 of 436 study participants (22.5%) had neurocognitive decline, while 72 (16.5%) improved their cognitive status, and 266 (61%) remained stable. All three groups had about 6 visits during follow-up and were similar in age (42.7 for decliners, 43.8 for improvers, and 44.2 for stable patients). The proportion of people with potential confounding neuropsychological comorbidities was significantly higher in decliners (20%) than in improvers (11%) or the stable group (8%).
The three response groups--decliners, improvers, and stable patients--did not differ substantially in nadir or current CD4 count or proportions on ART. But decliners were significantly more likely to have detectable HIV RNA in plasma (66% versus 50% in improvers versus 59% in stable patients) and in cerebrospinal fluid (47% versus 28% versus 41%).
Multivariate analysis identified three independent predictors of declining neuropsychological performance during follow-up:
-- Being off ART made neurocognitive decline 60% more likely (relative risk [RR] 1.6, 95% confidence interval [CI] 1.1 to 2.5, P = 0.025)
-- Lower CD4 count raised the risk 10% (RR 1.1, 95% CI 1.02 to 1.21, P = 0.017)
-- A confounding comorbidity when follow-up began more than doubled the risk (RR 2.4, 95% CI 1.4 to 4.0, P = 0.0015)
The CHARTER team believes their findings justify "prospective studies regarding the possible neuroprotective benefits of proactive ART and effective management of co-occurring central nervous system conditions for improving neurocognitive outcomes."
Reference
1. Heaton R, Deutsch R, Franklin D, et al; and the CHARTER Group. Prevalence and predictors of neurocognitive decline over 18 to 42 months: a CHARTER longitudinal study. 19th Conference on Retroviruses and Opportunistic Infections. March 5-8, 2012. Seattle. Abstract 474.
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