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Effects of Comorbidity Burden and Age on Brain Integrity in HIV
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Reported by Jules Levin
9th Annual Aging and HIV Workshop
New York, Sept 13-14 2018
HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy CHARTER Study: 40-83% Neuro Impaired/33% asymptomatic/low nadir cd4 predicts/comorbidities contribute
"Fifty-two percent of the total sample had NP impairment, with higher rates in groups with greater comorbidity burden (40%, 59%, and 83%). Prevalence estimates for specific HAND diagnoses (excluding severely confounded cases) were 33% for asymptomatic neurocognitive impairment, 12% for mild neurocognitive disorder, and only 2% for HIV-associated dementia (HAD). Among participants with minimal comorbidities (n = 843), history of low nadir CD4 was a strong predictor of impairment, and the lowest impairment rate on CART occurred in the subset with suppressed plasma viral loads and nadir CD4 ≥200 cells/mm3 (30% vs 47% in remaining subgroups). The most severe HAND diagnosis (HAD) was rare, but milder forms of impairment remained common, even among those receiving CART who had minimal comorbidities. Future studies should clarify whether early disease events (e.g., profound CD4 decline) may trigger chronic CNS changes, and whether early CART prevents or reverses these changes." - from Jules: I suspect 'legacy' event, that HIV infection itself in the brain/CNS causes irreparable/permanent damage, CD4 nadir contributes, comorbidities and HCV contribute AND immunosenescence contributes.
"A majority of the CHARTER participants (54.2%; n = 843) was classified as having only incidental comorbidities, and 30.4% (n = 473) had contributing conditions; 15.4% (n = 239) had confounding comorbidities that precluded a HAND diagnosis (see table 2 for details concerning rates of major comorbidities found in these three groups)."
Rowan Saloner, B.S.
SDSU/UCSD Joint Doctoral Program in Clinical Psychology
9th International Workshop on HIV & Aging
9/14/18
"Confounded PLWH [more severe comorbidities effects, see tables below listing the comorbid conditions] demonstrate distinct neurochemical abnormalities that are NOT moderated by age" but "Older age and severe comorbidity burden synergistically contribute to subcortical and white matter tissue injury". from Jules: you will note below that in this CHARTER group about 50% had undetectable viral load and many had low nadir CD4. In this original publication above low nadir CD4 increases rsk for cognitive impairment so one might question id having undetectable VL would remove the risk for actual structural brain damage seen in this study for those with more severe comorbidities, NO, I do not think having long term undetectable viral load remove the risk for structural brain damage, perhaps it could reduce risk but what of the impact of neurotoxicity of ART, past history of efavirenz or other effects of ART neurotoxicity.
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