TY - JOUR
T1 - Neuropsychological impairment in acute HIV and the effect of immediate antiretroviral therapy
AU - on behalf of the RV254/SEARCH 010 Study Group
AU - Kore, Idil
AU - Ananworanich, Jintanat
AU - Valcour, Victor
AU - Fletcher, James L.K.
AU - Chalermchai, Thep
AU - Paul, Robert
AU - Reynolds, Jesse
AU - Tipsuk, Somporn
AU - Ubolyam, Sasiwimol
AU - Rattanamanee, Somprartthana
AU - Jagodzinski, Linda
AU - Kim, Jerome
AU - Spudich, Serena
AU - Phanuphak, Praphan
AU - Phanuphak, Nittaya
AU - Teeratakulpisarn, Nipat
AU - Kroon, Eugene
AU - De Souza, Mark
AU - Chomchey, Nitiya
AU - Pinyakorn, Suteeraporn
AU - Trichavaroj, Rapee
AU - Assawadarachai, Vatcharain
AU - Tantibul, Nantana
AU - Nuntapinit, Bessara
AU - Akapirat, Siriwat
AU - Poltavee, Kultida
AU - Nampueng, A.
AU - Desai, Akash
AU - Chiao, Stephanie
AU - Busovaca, Edgar
AU - Wendelken, Lauren
AU - Tovanabutra, Sodsai
AU - Robb, Merlin
AU - Michael, Nelson
AU - Napolitano, Laura
AU - Martel, Molly
N1 - Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Objective: To investigate neuropsychological performance (NP) during acute HIV infection (AHI) before and after combination antiretroviral therapy (cART). Design: Prospective study of Thai AHI participants examined at 3 and 6 months after initiation of cART. Methods: Thirty-six AHI participants were evaluated pre-cART at median 19 days since HIV exposure and 3 and 6 months after cART with the Grooved Pegboard test, Color Trails 1 & 2 (CT1, CT2), and Trail Making Test A. Raw scores were standardized to 251 age- and education-matched HIV-uninfected Thais. To account for learning effects, change in NP performance was compared with that of controls at 6 months. Analyses included multivariable regression, nonparametric repeated measures analysis of variance, and Mann- Whitney U test. Results: Baseline NP scores for the AHI group were within normal range (z-scores range: -0.26 to -0.13). NP performance improved on CT1, CT2, and Trail Making Test A in the initial 3 months (P < 0.01) with no significant change during the last 3 months. Only improvement in CT1 was greater than that seen in controls at 6 months (P = 0.018). Participants who performed >1 SD below normative means on ≥2 tests (n = 8) exhibited higher baseline cerebrospinal fluid HIV RNA (P = 0.047) and had no improvement after cART. Conclusions: Most AHI individuals had normal NP performance, and early cART slightly improved their psychomotor function. However, approximately 25% had impaired NP performance, which correlated with higher cerebrospinal fluid HIV RNA, and these abnormalities were not reversed by early cART possibly indicating limited reversibility of cognitive impairment in a subset of AHI individuals.
AB - Objective: To investigate neuropsychological performance (NP) during acute HIV infection (AHI) before and after combination antiretroviral therapy (cART). Design: Prospective study of Thai AHI participants examined at 3 and 6 months after initiation of cART. Methods: Thirty-six AHI participants were evaluated pre-cART at median 19 days since HIV exposure and 3 and 6 months after cART with the Grooved Pegboard test, Color Trails 1 & 2 (CT1, CT2), and Trail Making Test A. Raw scores were standardized to 251 age- and education-matched HIV-uninfected Thais. To account for learning effects, change in NP performance was compared with that of controls at 6 months. Analyses included multivariable regression, nonparametric repeated measures analysis of variance, and Mann- Whitney U test. Results: Baseline NP scores for the AHI group were within normal range (z-scores range: -0.26 to -0.13). NP performance improved on CT1, CT2, and Trail Making Test A in the initial 3 months (P < 0.01) with no significant change during the last 3 months. Only improvement in CT1 was greater than that seen in controls at 6 months (P = 0.018). Participants who performed >1 SD below normative means on ≥2 tests (n = 8) exhibited higher baseline cerebrospinal fluid HIV RNA (P = 0.047) and had no improvement after cART. Conclusions: Most AHI individuals had normal NP performance, and early cART slightly improved their psychomotor function. However, approximately 25% had impaired NP performance, which correlated with higher cerebrospinal fluid HIV RNA, and these abnormalities were not reversed by early cART possibly indicating limited reversibility of cognitive impairment in a subset of AHI individuals.
KW - Antiretroviral therapy
KW - HIV infection
KW - HIV-associated neurocognitive disorder
KW - Mild cognitive impairment
KW - Neuropsychological tests
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U2 - 10.1097/QAI.0000000000000746
DO - 10.1097/QAI.0000000000000746
M3 - Article
C2 - 26509933
AN - SCOPUS:84945906042
SN - 1525-4135
VL - 70
SP - 393
EP - 399
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 4
ER -