Neurocognitive effects of treatment interruption in stable HIV-positive patients in an observational cohort
- PMID: 20237308
- PMCID: PMC2860482
- DOI: 10.1212/WNL.0b013e3181d9ed09
Neurocognitive effects of treatment interruption in stable HIV-positive patients in an observational cohort
Abstract
Objective: Prior studies have shown improved neurocognition with initiation of antiretroviral treatment (ART) in HIV. We hypothesized that stopping ART would be associated with poorer neurocognitive function.
Methods: Neurocognitive function was assessed as part of ACTG 5170, a multicenter, prospective observational study of HIV-infected subjects who elected to discontinue ART. Eligible subjects had CD4 count >350 cells/mm(3), had HIV RNA viral load <55,000 cp/mL, and were on ART (>or=2 drugs) for >or=6 months. Subjects stopped ART at study entry and were followed for 96 weeks with a neurocognitive examination.
Results: A total of 167 subjects enrolled with a median nadir CD4 of 436 cells/mm(3) and 4.5 median years on ART. Significant improvements in mean neuropsychological scores of 0.22, 0.39, 0.53, and 0.74 were found at weeks 24, 48, 72, and 96 (all p < 0.001). In the 46 subjects who restarted ART prior to week 96, no significant changes in neurocognitive function were observed.
Conclusion: Subjects with preserved immune function found that neurocognition improved significantly following antiretroviral treatment (ART) discontinuation. The balance between the neurocognitive cost of untreated HIV viremia and the possible toxicities of ART require consideration.
Classification of evidence: This study provides Class III evidence that discontinuing ART is associated with an improvement in 2 neuropsychological tests (Trail-Making Test A & B and the Wechsler Adult Intelligence Scale-Revised Digit Symbol subtest) for up to 96 weeks. Resuming ART was not associated with a decline in these scores for up to 45 weeks.
Figures
Comment in
-
Therapeutic conundrum: AIDS therapies may be double-edged swords.Neurology. 2010 Apr 20;74(16):1248-9. doi: 10.1212/WNL.0b013e3181dd4e31. Epub 2010 Mar 25. Neurology. 2010. PMID: 20338919 No abstract available.
References
-
- Hogg RS, Yip B, Chan KJ, et al. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. JAMA 2001;286:2568–2577. - PubMed
-
- Palella FJ, Jr., Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection: HIV Outpatient Study Investigators. N Engl J Med 1998;338:853–860. - PubMed
-
- Palella FJ, Jr., Deloria-Knoll M, Chmiel JS, et al. Survival benefit of initiating antiretroviral therapy in HIV-infected persons in different CD4+ cell strata. Ann Intern Med 2003;138:620–626. - PubMed
-
- Dore GJ, Correll PK, Li Y, Kaldor JM, Cooper DA, Brew BJ. Changes to AIDS dementia complex in the era of highly active antiretroviral therapy. AIDS 1999;13:1249–1253. - PubMed
-
- Department of Health, Human Services, Henry J. Kaiser Family Foundation. Guidelines for the use of antiretroviral agents in HIV-infected adults, adolescents. MMWR Recomm Rep 1998;47:43–82. - PubMed
Publication types
MeSH terms
Substances
Grants and funding
- 1U01AI069532-01/AI/NIAID NIH HHS/United States
- U01 AI069423/AI/NIAID NIH HHS/United States
- AI46370/AI/NIAID NIH HHS/United States
- 1U01AI069428-01/AI/NIAID NIH HHS/United States
- 1U01-AI069484/AI/NIAID NIH HHS/United States
- 5 U01-AI067854-04/AI/NIAID NIH HHS/United States
- U01 AI062677/AI/NIAID NIH HHS/United States
- R01 AI051219/AI/NIAID NIH HHS/United States
- M01 RR00047/RR/NCRR NIH HHS/United States
- U01 AI069502/AI/NIAID NIH HHS/United States
- 5-MO1 RR00044/RR/NCRR NIH HHS/United States
- AI069423-01/AI/NIAID NIH HHS/United States
- 1 R01 MH085597-01A1/MH/NIMH NIH HHS/United States
- AI069434/AI/NIAID NIH HHS/United States
- 5 U01 AI069423-03/AI/NIAID NIH HHS/United States
- U0I-AI069556/AI/NIAID NIH HHS/United States
- 5 U01 NS032228/NS/NINDS NIH HHS/United States
- 5U01AI032782/AI/NIAID NIH HHS/United States
- M01-RR00096/RR/NCRR NIH HHS/United States
- 1U01AI068636/AI/NIAID NIH HHS/United States
- 5 T32 AI007151-31/AI/NIAID NIH HHS/United States
- K24 AI51982/AI/NIAID NIH HHS/United States
- K24 AI051982/AI/NIAID NIH HHS/United States
- AI27661/AI/NIAID NIH HHS/United States
- AI069511-01/AI/NIAID NIH HHS/United States
- T32 AI060530/AI/NIAID NIH HHS/United States
- AI-68636/AI/NIAID NIH HHS/United States
- AI069495-01/AI/NIAID NIH HHS/United States
- P01 HD059454/HD/NICHD NIH HHS/United States
- UM1 AI069496/AI/NIAID NIH HHS/United States
- AI069424/AI/NIAID NIH HHS/United States
- 1U19AI082608-01/AI/NIAID NIH HHS/United States
- AI069494-01/AI/NIAID NIH HHS/United States
- 1 R34 AI084553-01/AI/NIAID NIH HHS/United States
- AI-069513/AI/NIAID NIH HHS/United States
- AI069423-03/AI/NIAID NIH HHS/United States
- AI069472/AI/NIAID NIH HHS/United States
- 5-P30-AI-045008-07/AI/NIAID NIH HHS/United States
- 3 U01 AI046376-05/AI/NIAID NIH HHS/United States
- AI069432/AI/NIAID NIH HHS/United States
- U62 CCU123541/PHS HHS/United States
- AI068634/AI/NIAID NIH HHS/United States
- R01 MH067751/MH/NIMH NIH HHS/United States
- AI069470-01/AI/NIAID NIH HHS/United States
- AI50410/AI/NIAID NIH HHS/United States
- AI069467-01/AI/NIAID NIH HHS/United States
- AI25859/AI/NIAID NIH HHS/United States
- P30 AI27763/AI/NIAID NIH HHS/United States
- RR00046/RR/NCRR NIH HHS/United States
- AI069471/AI/NIAID NIH HHS/United States
- P30 AI050410/AI/NIAID NIH HHS/United States
- R01 MH081772/MH/NIMH NIH HHS/United States
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials
Miscellaneous