Dynamics of cognitive change in impaired HIV-positive patients initiating antiretroviral therapy

被引:211
作者
Cysique, L. A. [1 ,5 ]
Vaida, F. [2 ]
Letendre, S. [3 ]
Gibson, S. [3 ]
Cherner, M. [1 ]
Woods, S. P. [1 ]
McCutchan, J. A. [3 ]
Heaton, R. K. [1 ]
Ellis, R. J. [4 ]
机构
[1] Univ Calif San Diego, Dept Psychiat, San Diego, CA 92103 USA
[2] Univ Calif San Diego, Div Biostat & Bioinformat, Dept Family & Prevent Med, San Diego, CA 92103 USA
[3] Univ Calif San Diego, Dept Med, San Diego, CA 92103 USA
[4] Univ Calif San Diego, Dept Neurosci, San Diego, CA 92103 USA
[5] Univ New S Wales, Sydney, NSW, Australia
关键词
TEST-PERFORMANCE; HAART; SUPPRESSION; INFECTION; SCORES; SPEED;
D O I
10.1212/WNL.0b013e3181ab2b3b
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To rigorously evaluate the time course of cognitive change in a cohort of individuals with HIV-associated neurocognitive disorders (HAND) initiating combination antiretroviral therapy (CART), and to investigate which demographic, laboratory, and treatment factors are associated with neuropsychological (NP) outcome (or "any NP improvement"). Methods: Study participants included 37 HIV + individuals with mild to moderate NP impairment who initiated CART and underwent NP testing at 12, 24, 36, and 48 weeks thereafter. NP change was assessed using a regression-based change score that was normed on a separate NP-stable group thereby controlling for regression toward the mean and practice effect. Mixed-effect regression models adjusting for loss to follow-up were used to evaluate the time course of cognitive change and its association with baseline and time-varying predictors. Results: In persons with HAND initiating CART, cognitive improvement happens soon after initiation (13% at week 12), but more often 24, 36, and up to 48 weeks after initiation (up to 41%), with fewer than 5% demonstrating significant worsening. In multivariate analyses, unique predictors of NP improvement included more severe baseline NP impairment and higher CART CNS penetration index. Greater viral load decrease was associated with NP improvement only in univariate analyses. Conclusion: Clinically meaningful neuropsychological improvement seemed to peak around 24-36 weeks after combination antiretroviral therapy initiation and was prolonged over the 1-year study period. This study also provides new evidence that benefit may be maximized by choosing antiretroviral medications that reach therapeutic concentrations in the CNS. Neurology (R) 2009; 73: 342-348
引用
收藏
页码:342 / 348
页数:7
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