Dynamics of cognitive change in impaired HIV-positive patients initiating antiretroviral therapy
- 4 August 2009
- journal article
- clinical trial
- Published by Wolters Kluwer Health in Neurology
- Vol. 73 (5), 342-348
- https://doi.org/10.1212/wnl.0b013e3181ab2b3b
Abstract
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"). 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. 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. 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.Keywords
This publication has 29 references indexed in Scilit:
- Clinical Outcomes After an Unstructured Treatment Interruption in Children and Adolescents With Perinatally Acquired HIV InfectionPediatrics, 2008
- Validation of the CNS Penetration-Effectiveness Rank for Quantifying Antiretroviral Penetration Into the Central Nervous SystemArchives of Neurology, 2008
- Updated research nosology for HIV-associated neurocognitive disordersNeurology, 2007
- Efficient hybrid EM for linear and nonlinear mixed effects models with censored responseComputational Statistics & Data Analysis, 2007
- Practice Effects Associated with the Repeated Assessment of Cognitive Function Using the CogState Battery at 10-minute, One Week and One Month Test-retest IntervalsJournal of Clinical and Experimental Neuropsychology, 2006
- Medication adherence in HIV-infected adultsAIDS, 2004
- The effects of practice on the cognitive test performance of neurologically normal individuals assessed at brief test–retest intervalsJournal of the International Neuropsychological Society, 2003
- Practice Effects on the WAIS-III Across 3- and 6-Month IntervalsThe Clinical Neuropsychologist, 2002
- Detecting change: A comparison of three neuropsychological methods, using normal and clinical samplesArchives of Clinical Neuropsychology, 2001
- “TScores for Change”: An illustration of a regression approach to depicting change in clinical neuropsychologyThe Clinical Neuropsychologist, 1993