Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 1;35(6):883-888.
doi: 10.1097/QAD.0000000000002831.

Cognitive trajectories after treatment in acute HIV infection

Phillip Chan  1 , Stephen J Kerr  2   3 , Eugène Kroon  1 , Donn Colby  1   4 , Carlo Sacdalan  1 , Joanna Hellmuth  5 , Peter Reiss  6 , Sandhya Vasan  4   7 , Jintanat Ananworanich  1   6 , Victor Valcour  5 , Serena Spudich  8 , Robert Paul  9 ; RV254/SEARCH 010 Research Team
Affiliations

Cognitive trajectories after treatment in acute HIV infection

Phillip Chan et al. AIDS. .

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.

PubMed Disclaimer

References

    1. Heaton RK, Franklin DR Jr, Deutsch R, Letendre S, Ellis RJ, Casaletto K, et al. Neurocognitive change in the era of HIV combination antiretroviral therapy: the longitudinal CHARTER study . Clin Infect Dis 2015; 60:473–480.
    1. Evering TH, Applebaum A, La Mar M, Garmon D, Dorfman D, Markowitz M. Rates of nonconfounded HIV-associated neurocognitive disorders in men initiating combination antiretroviral therapy during primary infection . AIDS 2016; 30:203–210.
    1. Kore I, Ananworanich J, Valcour V, Fletcher JL, Chalermchai T, Paul R, et al. Neuropsychological impairment in acute HIV and the effect of immediate antiretroviral therapy . J Acquir Immune Defic Syndr 2015; 70:393–399.
    1. Brouillette MJ, Yuen T, Fellows LK, Cysique LA, Heaton RK, Mayo NE. Identifying neurocognitive decline at 36 months among HIV-positive participants in the CHARTER cohort using group-based trajectory analysis . PLoS One 2016; 11:e0155766.
    1. Gott C, Gates T, Dermody N, Brew BJ, Cysique LA. Cognitive change trajectories in virally suppressed HIV-infected individuals indicate high prevalence of disease activity . PLoS One 2017; 12:e0171887.

Publication types