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Rates of Non-confounded HIV-Associated Neurocognitive Disorder after Early cART..... "Our findings suggest substantial neuroprotective benefit of initiating cART during primary infection"
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Reported by Jules Levin
CROI 2015 Feb 23-26, Seattle, WA
Teresa H. Evering1, Allison Applebaum2 , Melissa La Mar1, Donald Garmon1 , David Dorfman3 and Martin Markowitz1
1Aaron Diamond AIDS Research Center, an affiliate of the Rockefeller University, New York, NY, USA, 2Memorial Sloan-Kettering Cancer Center,
New York, NY, USA, 3Mount Sinai School of Medicine, New York, NY, USA
"Observed rates of HAND in this cohort of HIV-infected individuals without confounding comorbidities that initiated cART during acute/early infection are low......."We investigated the prevalence of non-confounded HAND in an HIV positive cohort who previously initiated long-term cART with a median duration of infection of 1.6 months.....Only 1 participant in the study group (1/26 = 4%) was impaired with a GDS of 0.60........Median duration of cART prior to enrollment was 5.7 years (2.2-9.9)......Our findings suggest substantial neuroprotective benefit of initiating cART during primary infection, but also highlight the pervasiveness of comorbid illness in those with HIV and suggest a significant contribution of comorbidities to observed HAND prevalence......Forty individuals screened and a high screen failure (SF) rate (14/40 = 35%) was observed. The most common reasons for SF were active methamphetamine/other substance dependence (5/14 = 36%) and active bipolar disorder (3/14 = 21%)."
"The Beck Depression Inventory (BDI) was used to determine severity of depressive symptoms. We assessed neurocognitive (NC) function comprehensively and those with global deficit scores (GDS) >0.50 were considered impaired .......Exclusion criteria were adapted from Rippeth et al.5 and included treatment interruption since cART initiation, severe neuropsychiatric disorder, active major depressive disorder, DSM-IV diagnostic criteria for alcohol/substance abuse or dependence within 1 year prior to screen (excluding marijuana), untreated syphilis and positive hepatitis C serology."
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program abstract-
Rates of Nonconfounded HIV-Associated Neurocognitive Disorder After Early cART
Teresa H. Evering1; Allison Applebaum2; Melissa La Mar1; Donald Garmon1; David Dorfman3; Martin Markowitz1
1Aaron Diamond AIDS Research Center, an Affiliate of the Rockefeller University, New York, NY, US; 2Memorial Sloan-Kettering Cancer Center, New York, NY, US; 3Mount Sinai School of Medicine, New York, NY, US
Background: HIV-Associated Neurocognitive Disorder (HAND) is an important complication of chronic HIV-infection with an estimated prevalence ranging from 19 - 45%.We investigated the prevalence of non-confounded HAND in an HIV positive cohort who previously initiated long-term cART with a median duration of infection of 1.6 months.
Methods: Participants were randomly selected from the ADARC Primary HIV-1 Infection Cohort. Exclusion criteria included: treatment interruption since cART initiation, severe neuropsychiatric disorder, active major depressive disorder, DSM-IV diagnostic criteria for alcohol/substance abuse or dependence within 1 year prior to screen (excluding marijuana), untreated syphilis and positive hepatitis C serology. The Beck Depression Inventory (BDI) was used to determine severity of depressive symptoms. We assessed neurocognitive (NC) function comprehensively and those with global deficit scores (GDS) >0.50 were considered impaired.Associations between GDS scores and clinical parameters were evaluated using multiple linear regression.
Results: Forty individuals screened and a high screen failure (SF) rate (14/40 = 35%) was observed. The most common reasons for SF were active methamphetamine/other substance dependence (5/14 = 36%) and active bipolar disorder (3/14 = 21%).Twenty-six, primarily non-Hispanic white (73%), male (100%) subjects were enrolled and underwent NC assessment. Mean age was 43 (28-71) years, with a median of 17 years of education (13-24).Median current and nadir plasma CD4+ T cell counts were 828 (506-1411) and 359 (150-621) cells/mL. Median duration of cART prior to enrollment was 5.7 years (2.2-9.9). Median 2010 CPE score at study entry was 7 (6-10) and all participants had plasma HIV-1 RNA <50 copies/ml at this time. Median BDI score was 1 (0-13). Median GDS was 0.17 (0.00-0.50).Only 1 (4%) participant was impaired.There was no association between GDS and any clinical/immunologic parameter (p > 0.27, all variables). Individuals failing screening were demographically similar to those enrolled.
Conclusions: Observed rates of HAND in this cohort of HIV-infected individuals without confounding comorbidities that initiated cART during acute/early infection are low.Our findings suggest substantial neuroprotective benefit of initiating cART during primary infection, but also highlight the pervasiveness of comorbid illness in those with HIV and suggest a significant contribution of comorbidities to observed HAND prevalence.
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Program abstract-
Rates of Nonconfounded HIV-Associated Neurocognitive Disorder After Early cART
Teresa H. Evering1; Allison Applebaum2; Melissa La Mar1; Donald Garmon1; David Dorfman3; Martin Markowitz1
1Aaron Diamond AIDS Research Center, an Affiliate of the Rockefeller University, New York, NY, US; 2Memorial Sloan-Kettering Cancer Center, New York, NY, US; 3Mount Sinai School of Medicine, New York, NY, US
Background: HIV-Associated Neurocognitive Disorder (HAND) is an important complication of chronic HIV-infection with an estimated prevalence ranging from 19 - 45%.We investigated the prevalence of non-confounded HAND in an HIV positive cohort who previously initiated long-term cART with a median duration of infection of 1.6 months.
Methods: Participants were randomly selected from the ADARC Primary HIV-1 Infection Cohort.Exclusion criteria included: treatment interruption since cART initiation, severe neuropsychiatric disorder, active major depressive disorder, DSM-IV diagnostic criteria for alcohol/substance abuse or dependence within 1 year prior to screen (excluding marijuana), untreated syphilis and positive hepatitis C serology.The Beck Depression Inventory (BDI) was used to determine severity of depressive symptoms.We assessed neurocognitive (NC) function comprehensively and those with global deficit scores (GDS) >0.50 were considered impaired.Associations between GDS scores and clinical parameters were evaluated using multiple linear regression.
Results: Forty individuals screened and a high screen failure (SF) rate (14/40 = 35%) was observed.The most common reasons for SF were active methamphetamine/other substance dependence (5/14 = 36%) and active bipolar disorder (3/14 = 21%).Twenty-six, primarily non-Hispanic white (73%), male (100%) subjects were enrolled and underwent NC assessment.Mean age was 43 (28-71) years, with a median of 17 years of education (13-24).Median current and nadir plasma CD4+ T cell counts were 828 (506-1411) and 359 (150-621) cells/mL.Median duration of cART prior to enrollment was 5.7 years (2.2-9.9).Median 2010 CPE score at study entry was 7 (6-10) and all participants had plasma HIV-1 RNA <50 copies/ml at this time.Median BDI score was 1 (0-13).Median GDS was 0.17 (0.00-0.50).Only 1 (4%) participant was impaired.There was no association between GDS and any clinical/immunologic parameter (p > 0.27, all variables).Individuals failing screening were demographically similar to those enrolled.
Conclusions: Observed rates of HAND in this cohort of HIV-infected individuals without confounding comorbidities that initiated cART during acute/early infection are low.Our findings suggest substantial neuroprotective benefit of initiating cART during primary infection, but also highlight the pervasiveness of comorbid illness in those with HIV and suggest a significant contribution of comorbidities to observed HAND prevalence.
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