Neurocognitive Decline with HIV Infection

Richard T. Ellison III, MD reviewing Grant I et al. Neurology 2014 May 9. Albert SM and Martin EM.Neurology 2014 May 9.

 

Asymptomatic HIV-associated neurocognitive impairment is a risk factor for future symptomatic neurological decline.

 

With the decline in morbidity and mortality from opportunistic infections and cancers in the combination antiretroviral therapy era, one of the most frightening possible complications of HIV infection is neurological decline. Previous research has shown that asymptomatic neurocognitive impairment (ANI; impairment in ≥2 domains on formal neuropsychological testing, without apparent functional impairment in everyday life) affects a sizable number of HIV-infected individuals.

In a recent investigation involving 347 CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study participants, investigators assessed whether the presence of ANI increases the risk for future neurological decline. Neurocognitive assessments were conducted approximately every 6 months (median follow-up duration, 45.2 months).

At baseline, 121 individuals had ANI and 226 were neurocognitively normal; those with ANI had a higher educational level, a lower estimated verbal IQ, a lower nadir CD4 count (162 vs. 201 cells/mm3), and a higher incidence of comorbid conditions (44.6% vs. 22.6%), and a higher likelihood of an undetectable cerebrospinal fluid viral load (75.9% vs. 59.6%). A higher proportion of participants with ANI went on to develop symptomatic neurological decline (50.4% vs. 21.7%), as determined by self-report or performance-based assessment, and the neurological decline was noted earlier in those with ANI than in those who were neurocognitively normal at baseline. Risk factors for neurological decline, in addition to ANI, included older age, lower educational level, female sex, substance abuse, and lower nadir CD4-cell count.

COMMENT

These findings suggest that ANI is a notable risk factor for neurological decline in HIV-infected patients, and that a sizable proportion of HIV-infected patients will develop measurable decline. As noted by editorialists, it remains unclear whether these findings are applicable to other HIV populations, such as those with less-advanced disease or a lower prevalence of substance abuse.

CITATION(S):

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  2. Albert SM and Martin EM.HIV and the neuropsychology of everyday life. Neurology 2014 May 9; [e-pub ahead of print]. (http://dx.doi.org/10.1212/WNL.0000000000000506)