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Multicenter Study
. 2019 May 2;68(10):1733-1738.
doi: 10.1093/cid/ciy767.

Human Immunodeficiency Virus-associated Neurocognitive Impairment in Diverse Resource-limited Settings

Kevin R Robertson  1 , Hongyu Jiang  2 , Johnstone Kumwenda  3 , Khuanchai Supparatpinyo  4 , Christina M Marra  5 , Baiba Berzins  6 , James Hakim  7 , Ned Sacktor  8 , Thomas B Campbell  9 , Jeffrey Schouten  10 , Katie Mollan  1 , Srikanth Tripathy  11 , Nagalingeswaran Kumarasamy  12 , Alberto La Rosa  13 , Breno Santos  14 , Marcus T Silva  15 , Cecilia Kanyama  16 , Cindy Firhnhaber  17 , Robert Murphy  6 , Colin Hall  1 , Cheryl Marcus  1 , Linda Naini  18 , Reena Masih  18 , Mina C Hosseinipour  1   16 , Rosie Mngqibisa  19 , Sharlaa Badal-Faesen  17 , Sarah Yosief  1 , Alyssa Vecchio  20 , Apsara Nair  21 ; AIDS Clinical Trials Group
Affiliations
Multicenter Study

Human Immunodeficiency Virus-associated Neurocognitive Impairment in Diverse Resource-limited Settings

Kevin R Robertson et al. Clin Infect Dis. .

Abstract

Background: Neurocognitive impairment remains a common complication of human immunodeficiency virus (HIV) despite effective antiretroviral therapy (ART). We previously reported improved neurocognitive functioning with ART initiation in 7 resource-limited countries for HIV+ participants from the AIDS Clinical Trials Group (ACTG) 5199 International Neurological Study (INS). Here, we apply normative data from the International Neurocognitive Normative Study (INNS) to INS to provide previously unknown rates of neurocognitive impairment.

Methods: The A5199 INS assessed neurocognitive and neurological performance within a randomized clinical trial with 3 arms containing World Health Organization first-line recommended ART regimens (ACTG 5175; PEARLS). The ACTG 5271 INNS collected normative comparison data on 2400 high-risk HIV-negative participants from 10 voluntary counseling and testing sites aligned with INS. Normative comparison data were used to create impairment ratings for HIV+ participants in INS; associations were estimated using generalized estimating equations.

Results: Among 860 HIV+ adults enrolled in ACTG 5199, 55% had no neurocognitive impairment at baseline. Mild neurocognitive impairment was found in 25%, moderate in 17%, and severe in 3% of participants. With the initiation of ART, the estimated odds of impairment were reduced 12% (95% confidence interval, 9%, 14%) for every 24 weeks (P < .0001) on ART. Mild impairment dropped slightly and then remained at about 18% out to week 168.

Conclusions: Almost half of HIV+ participants had neurocognitive impairment at baseline before ART, based on local norms. With ART initiation, there were significant overall reductions in neurocognitive impairment over time, especially in those with moderate and severe impairments.

Clinical trials registration: NCT00096824.

Keywords: HIV-associated neurocognitive disorders; antiretroviral; international settings; neurocognitive; neurology.

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Figures

Figure 1.
Figure 1.
Change in prevalence of neurocognitive impairment following treatment initiation. Abbreviations: ART, antiretroviral therapy.
Figure 2.
Figure 2.
Estimated neurocognitive impairment over time. Abbreviations: ART, antiretroviral therapy.
Figure 3.
Figure 3.
Incidence of neurocognitive impairment and improvement on study from baseline to last visit.
See this image and copyright information in PMC

References

    1. Antinori A, Arendt G, Becker JT, et al. . Updated research nosology for HIV-associated neurocognitive disorders. Neurology 2007; 69:1789–99. - PMC - PubMed
    1. Robertson KR, Smurzynski M, Parsons TD, et al. . The prevalence and incidence of neurocognitive impairment in the HAART era. AIDS 2007; 21:1915–21. - PubMed
    1. Robertson KR, Hall CD. Assessment of neuroAIDS in the international setting. J Neuroimmune Pharmacol 2007; 2:105–11. - PubMed
    1. Robertson K, Liner J, Heaton R. Neuropsychological assessment of HIV-infected populations in international settings. Neuropsychol Rev 2009; 19:232–49. - PMC - PubMed
    1. Robertson K, Kumwenda J, Supparatpinyo K, et al. . A multinational study of neurological performance in antiretroviral therapy-naive HIV-1-infected persons in diverse resource-constrained settings. J Neurovirol 2011; 17:438–47. - PMC - PubMed

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