Cognitive trajectories after treatment in acute HIV infection
Year: 2021
Type: article
Abstract: OBJECTIVE: People with HIV continue to exhibit cognitive symptoms after suppressive antiretroviral therapy (ART). It remains unclear if initiating ART during acute HIV-1 infection (AHI) uniformly improves cognitive outcomes. METHODS: Sixty-seven individuals (96% men, median age 28 years) initiated ART immediately after AHI diagnosis and maintained viral suppression for 6 years. They underwent a four-test neuropsychological battery that measured fine motor speed and dexterity, psychomotor speed, and executive functioning at baseline (pre-ART AHI), weeks 12, 24 and 96, and annually thereafter through week 288. Performances were standardized to calculate an overall (NPZ-4) score and frequencies of impaired cognitive performance (≤-1 SD on at least two tests, or ≤-2 SD on at least one test). Group-based trajectory analysis (GBTA) was applied to identify distinct neuropsychological trajectories modelled from baseline to week 288. Posthoc analyses examined HIV-1 and demographic factors that differed between trajectory subgroups. RESULTS: NPZ-4 scores improved from baseline to week 96 (P < 0.001) and from weeks 96 to 288 (P < 0.001), with frequencies of impaired performance of 30, 6 and 2% at the respective time-points. The amplitude of NPZ-4 improvement throughout the period was more than 0.5 SD and beyond practice effects. GBTA identified three NPZ-4 trajectory subgroups that all showed improvement over-time. The subgroup with lowest baseline performance exhibited worse depressive symptoms at baseline (P = 0.04) and the largest improvement among the three. HIV-1 indices did not differ between the subgroups. CONCLUSION: Cognitive performance improved in a sustained and stable manner after initiating ART during AHI. Largest improvements were seen in participants with worst baseline cognitive performance.
Source: AIDS
Institutions: Chulalongkorn University, HIV Netherlands Australia Thailand Research Collaboration, Walter Reed Army Institute of Research, University of California, San Francisco, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, University of Amsterdam, Henry M. Jackson Foundation, Yale University, University of Missouri–St. Louis, Missouri Institute of Mental Health
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: green
Funders: U.S. Department of Defense, U.S. Department of Health and Human Services, Henry M. Jackson Foundation, Gilead Sciences, ViiV Healthcare, Chulalongkorn University, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, National Institute of Neurological Disorders and Stroke
Awards: Therapeutic Interventions during Acute Infection to Address the CNS Reservoir for, G1157507293, Defining the clinical utility of CSF biomarkers of neurodegeneration in HIV+ elders, Critical Role of Cytotoxic T Cells in HIV Neuropathogenesis, Impact of Treatment on Brain Integrity in the Earliest Stages of HIV Infection, G3818830583, G4180294558, G5334674987
OpenAlex ID: W3128697336