Highly active antiretroviral treatment in HIV infection:... : AIDS (original) (raw)

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benefits for neuropsychological function

Ferrando, Stephen1,2; van Gorp, Wilfred1; McElhiney, Martin1; Goggin, Kathy1; Sewell, Margaret1; Rabkin, Judith1

1HIV Clinical Research Program, Cornell University Medical College, New York, New York, USA.

2Requests for reprints to: Dr Stephen Ferrando, HIV Clinical Research Program, Cornell University Medical College, 445 East 68 Street, 3K, New York NY 10021, USA.

Sponsorship: This work was supported by National Institutes of Mental Health grant no. MH42277-11.

Note: This research program was initiated by the late Samuel Perry, MD, and this work is a legacy of his commitment to research on the neuropsychiatric aspects of HIV/AIDS.

Date of receipt: 16 January 1998; revised: 23 February 1998; accepted: 27 February 1998.

Abstract

Objectives:

To determine whether highly active antiretroviral therapy (HAART) is associated with reduced HIV-associated neuropsychological impairment.

Design:

Cross-sectional analysis in a natural history study of adaptation to HIV/AIDS.

Method:

A sample of 130 homo-/bisexual men with HIV/AIDS (mean age, 41 years; 42% non-white) were evaluated with a neuropsychological battery assessing attention, concentration, psychomotor speed, learning, memory and executive function. Subjects taking HAART were compared with those not taking HAART on demographics, CD4 cell count, viral load, scores on individual neuropsychological tests and proportion with neuropsychological impairment.

Results:

Sixty-nine (53%) subjects were taking HAART, and 48 (37%) were neuropsychologically impaired. Subjects taking HAART had lower mean CD4 cell counts than those not taking HAART (254 versus 342 × 106/l; P < 0.05), although they were more likely to have undetectable viral load (42 versus 20%; P < 0.01) and were less likely to be neuropsychologically impaired (22 versus 54%; P < 0.0001). Subjects taking HAART performed significantly better on tests of attention, concentration, learning, memory, and psychomotor speed. After excluding subjects with potential non-HIV confounders of neuropsychological function, those without neuropsychological impairment had significantly lower mean viral load levels and were more likely to have undetectable viral load than those with impairment.

Conclusion:

These preliminary findings suggest that HAART benefits neuropsychological function through the reduction of viral load.