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J Acquir Immune Defic Syndr. 2015 Dec 1;70(4):393-9. doi: 10.1097/QAI.0000000000000746.

Neuropsychological Impairment in Acute HIV and the Effect of Immediate Antiretroviral Therapy.

Author information

1
*Yale University School of Medicine, New Haven, CT; †SEARCH, The Thai Red Cross AIDS Research Center, Bangkok, Thailand; ‡US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; §Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD; ‖University of California, San Francisco, CA; ¶Missouri Institute of Mental Health, University of Missouri, St. Louis, MO; #Yale Center for Analytical Sciences, New Haven, CT; and **HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand.

Abstract

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.

PMID:
26509933
PMCID:
PMC4625393
DOI:
10.1097/QAI.0000000000000746
[Indexed for MEDLINE]
Free PMC Article

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