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Clin Infect Dis. 2019 May 2;68(10):1733-1738. doi: 10.1093/cid/ciy767.

Human Immunodeficiency Virus-associated Neurocognitive Impairment in Diverse Resource-limited Settings.

Author information

1
University of North Carolina, Chapel Hill, Massachusetts.
2
Harvard Chan School of Public Health, Boston, Massachusetts.
3
Queen Elizabeth College of Medicine-Johns Hopkins Project, Blantyre, Malawi.
4
Chiang Mai University, Thailand.
5
University of Washington, Seattle.
6
Northwestern University, Chicago, Illinois.
7
University of Zimbabwe, Harare.
8
Johns Hopkins University, Baltimore, Maryland.
9
University of Colorado Health Sciences Center, Denver.
10
Fred Hutchinson Cancer Center and University of Washington, Seattle.
11
National AIDS Research Institute, Pune, India.
12
Gaitonde Centre for AIDS Research and Education, Chennai, India.
13
Asociacion Civil Impacta Salud y Educacion, Lima, Peru.
14
Hospital Conceicao, Porto Alegre, Brazil.
15
Fiocruz, Rio De Janeiro, Brazil.
16
UNC Project-Malawi, Lilongwe, Malawi.
17
University of Witwatersrand, Johannesburg, South Africa.
18
Social Scientific Systems, Silver Springs, Maryland.
19
Durban International CRS, South Africa.
20
Universita Vita - Salute San Raffaele, Milan, Italy.
21
Frontier Science & Technology Research Foundation, Buffalo, New York.

Abstract

BACKGROUND:

Neurocognitive impairment remains a common complication of human immunodeficiency virus (HIV) despite effective antiretroviral therapy (ART). We previously reported improved neurocognitive functioning with ART initiation in 7 resource-limited countries for HIV+ participants from the AIDS Clinical Trials Group (ACTG) 5199 International Neurological Study (INS). Here, we apply normative data from the International Neurocognitive Normative Study (INNS) to INS to provide previously unknown rates of neurocognitive impairment.

METHODS:

The A5199 INS assessed neurocognitive and neurological performance within a randomized clinical trial with 3 arms containing World Health Organization first-line recommended ART regimens (ACTG 5175; PEARLS). The ACTG 5271 INNS collected normative comparison data on 2400 high-risk HIV-negative participants from 10 voluntary counseling and testing sites aligned with INS. Normative comparison data were used to create impairment ratings for HIV+ participants in INS; associations were estimated using generalized estimating equations.

RESULTS:

Among 860 HIV+ adults enrolled in ACTG 5199, 55% had no neurocognitive impairment at baseline. Mild neurocognitive impairment was found in 25%, moderate in 17%, and severe in 3% of participants. With the initiation of ART, the estimated odds of impairment were reduced 12% (95% confidence interval, 9%, 14%) for every 24 weeks (P < .0001) on ART. Mild impairment dropped slightly and then remained at about 18% out to week 168.

CONCLUSIONS:

Almost half of HIV+ participants had neurocognitive impairment at baseline before ART, based on local norms. With ART initiation, there were significant overall reductions in neurocognitive impairment over time, especially in those with moderate and severe impairments.

CLINICAL TRIALS REGISTRATION:

NCT00096824.

KEYWORDS:

HIV-associated neurocognitive disorders; antiretroviral; international settings; neurocognitive; neurology

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