22 February 2013
US military beneficiaries diagnosed with HIV and cared for early in the course of infection had a neurocognitive impairment rate similar to that of a matched group of military beneficiaries without HIV. The findings suggest that early HIV diagnosis and management may forestall development of neurocognitive problems in HIV-positive people.
Neurocognitive impairment remains frequent among people with HIV infection despite good responses to combination antiretroviral therapy. Because there is little information on how the timing of HIV diagnosis and management affects development of neurocognitive impairment, US researchers planned this analysis of military beneficiaries. Everyone entering the US military is HIV negative and undergoes regular mandatory HIV testing.
The investigators divided the 200-person HIV group into those with shorter and longer durations of HIV infection. They defined shorter-duration HIV as infection for fewer than 6 years, no AIDS-defining conditions, and a CD4-cell nadir above 200 cells/µL. Study participants with longer-duration HIV infection did not meet any of these criteria. The researchers selected 50 HIV-negative participants, matching them to the HIV group for age, gender, race/ethnicity, and military rank. All study participants received a comprehensive battery of neuropsychological tests to assess neurocognitive impairment
HIV-positive participants had a median age of 36 years. Almost two thirds (64%) were taking combination antiretroviral therapy, which started a median of 1.3 years after HIV diagnosis at a median CD4 count of 333 cells/µL (interquartile range [IQR] 248 to 423). Median CD4 count among HIV-positive participants not taking antiretrovirals was 523 (IQR 417 to 685).
Thirty-eight HIV-positive participants (19%) had neurocognitive impairment, and the rate did not differ significantly between those with earlier HIV infection and later HIV infection (18% versus 20%, P = 0.72). These rates were nonsignificantly lower than the 30% prevalence of neurocognitive impairment in the matched HIV-negative participants.
The researchers note that most HIV-positive participants classified as having longer-duration HIV infection had relatively high CD4 counts and few AIDS-defining conditions. The authors believe the low prevalence of neurocognitive impairment in HIV-positive people diagnosed and cared for early in the course of infection suggests that “early recognition and management of HIV infection may be important in limiting neurocognitive impairment.”
Source: Nancy F. Crum-Cianflone, David J. Moore, Scott Letendre, Mollie Poehlman Roediger, Lynn Eberly, Amy Weintrob, Anuradha Ganesan, Erica Johnson, Raechel Del Rosario, Brian K. Agan, Braden R. Hale. Low prevalence of neurocognitive impairment in early diagnosed and managed HIV-infected persons. Neurology. 2013; 80: 371-379.
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