Neuropsychological Testing Impairment In Acute Hiv And The Effects Of Immediate Antiretroviral Therapy

Acute HIV infection (AHI) is accompanied by central nervous system infection and immune activation. We investigated baseline predictors of neuropsychological (NP) performance in Thai participants with AHI and the effect of antiretroviral therapy (ART) on domains of functioning known to be affected by HIV. 36 participants with AHI (89% male, median age of 28 years, median time since HIV exposure of 19 days) were evaluated at baseline and 3 and 6 months after ART. Performance on the Grooved Pegboard test (GP), Color Trails 1 & 2 (CT1, CT2), and Trails Making Test A (TM) were standardized to 251 age and education matched HIV-uninfected Thais and summarized as a composite score (NPZ-4). Change in NP performance from baseline to 6 months was compared between AHI participants and matched Thai HIV- controls (n=45, 51% male, median age of 36 years) to account for practice effects. Analyses included Spearman correlation, multivariable regression, non-parametric repeated measures ANOVA, and Mann-Whitney U test. Baseline NP scores for the AHI group were similar to controls on each test (z scores range: -0.26 to -0.13). NP performance was negatively correlated with cerebrospinal fluid (CSF) HIV RNA (r = -0.493, p = 0.023) and days post-transmission (r = -0.389, p = 0.019). NP performance improved on CT1, CT2, and TM in the initial 3 months (ps \u3c0.01) 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). Eight participants performed \u3e1 standard deviation below normative means on \u3e2 NP tests at baseline. This subgroup had higher cerebrospinal fluid (CSF) HIV RNA compared to the rest of the AHI group (p=0.047) and exhibited no improvement in NP performance across the follow-up periods. Most AHI individuals had normal NP performance and early ART slightly improved their psychomotor function. However, approximately 25% of AHI individuals had impaired NP performance which correlated with higher CSF HIV RNA, and these abnormalities were not reversed by early short-term ART possibly indicating limited reversibility of cognitive impairment in a subset of AHI individuals

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

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