Phillip Chan1, Stephen J Kerr2,3, Eugène Kroon1, Donn Colby1,4, Carlo Sacdalan1, Joanna Hellmuth5, Peter Reiss6, Sandhya Vasan4,7, Jintanat Ananworanich1,6, Victor Valcour5, Serena Spudich8, Robert Paul9. 1. SEARCH. 2. HIV-NAT, Thai Red Cross AIDS Research Centre. 3. Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland. 5. Memory and Aging Center, Department of Neurology, University of California San Francisco, California, USA. 6. Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands. 7. The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland. 8. Center for Neuroepidemiology and Clinical Neurological Research, Yale University, New Haven, Connecticut. 9. Missouri Institute of Mental Health, University of Missouri-St. Louis, Missouri, USA.
Abstract
OBJECTIVE: People with HIV continue to exhibit cognitive symptoms after suppressive antiretroviral therapy (ART). It remains unclear if initiating ART during acute HIV-1 infection (AHI) uniformly improves cognitive outcomes. METHODS: Sixty-seven individuals (96% men, median age 28 years) initiated ART immediately after AHI diagnosis and maintained viral suppression for 6 years. They underwent a four-test neuropsychological battery that measured fine motor speed and dexterity, psychomotor speed, and executive functioning at baseline (pre-ART AHI), weeks 12, 24 and 96, and annually thereafter through week 288. Performances were standardized to calculate an overall (NPZ-4) score and frequencies of impaired cognitive performance (≤-1 SD on at least two tests, or ≤-2 SD on at least one test). Group-based trajectory analysis (GBTA) was applied to identify distinct neuropsychological trajectories modelled from baseline to week 288. Posthoc analyses examined HIV-1 and demographic factors that differed between trajectory subgroups. RESULTS: NPZ-4 scores improved from baseline to week 96 (P < 0.001) and from weeks 96 to 288 (P < 0.001), with frequencies of impaired performance of 30, 6 and 2% at the respective time-points. The amplitude of NPZ-4 improvement throughout the period was more than 0.5 SD and beyond practice effects. GBTA identified three NPZ-4 trajectory subgroups that all showed improvement over-time. The subgroup with lowest baseline performance exhibited worse depressive symptoms at baseline (P = 0.04) and the largest improvement among the three. HIV-1 indices did not differ between the subgroups. CONCLUSION: Cognitive performance improved in a sustained and stable manner after initiating ART during AHI. Largest improvements were seen in participants with worst baseline cognitive performance.
OBJECTIVE: People with HIV continue to exhibit cognitive symptoms after suppressive antiretroviral therapy (ART). It remains unclear if initiating ART during acute HIV-1 infection (AHI) uniformly improves cognitive outcomes. METHODS: Sixty-seven individuals (96% men, median age 28 years) initiated ART immediately after AHI diagnosis and maintained viral suppression for 6 years. They underwent a four-test neuropsychological battery that measured fine motor speed and dexterity, psychomotor speed, and executive functioning at baseline (pre-ART AHI), weeks 12, 24 and 96, and annually thereafter through week 288. Performances were standardized to calculate an overall (NPZ-4) score and frequencies of impaired cognitive performance (≤-1 SD on at least two tests, or ≤-2 SD on at least one test). Group-based trajectory analysis (GBTA) was applied to identify distinct neuropsychological trajectories modelled from baseline to week 288. Posthoc analyses examined HIV-1 and demographic factors that differed between trajectory subgroups. RESULTS: NPZ-4 scores improved from baseline to week 96 (P < 0.001) and from weeks 96 to 288 (P < 0.001), with frequencies of impaired performance of 30, 6 and 2% at the respective time-points. The amplitude of NPZ-4 improvement throughout the period was more than 0.5 SD and beyond practice effects. GBTA identified three NPZ-4 trajectory subgroups that all showed improvement over-time. The subgroup with lowest baseline performance exhibited worse depressive symptoms at baseline (P = 0.04) and the largest improvement among the three. HIV-1 indices did not differ between the subgroups. CONCLUSION: Cognitive performance improved in a sustained and stable manner after initiating ART during AHI. Largest improvements were seen in participants with worst baseline cognitive performance.
Authors: August A Longino; Robert Paul; Yixin Wang; Javier R Lama; Peter Brandes; Eduardo Ruiz; Cecilia Correa; Sheila Keating; Serena S Spudich; Christopher Pilcher; Alyssa Vecchio; Siavash Pasalar; Rachel A Bender Ignacio; Rogelio Valdez; Sayan Dasgupta; Kevin Robertson; Ann Duerr Journal: J Acquir Immune Defic Syndr Date: 2022-02-01 Impact factor: 3.771
Authors: Michael J Corley; Carlo Sacdalan; Alina P S Pang; Nitiya Chomchey; Nisakorn Ratnaratorn; Victor Valcour; Eugene Kroon; Kyu S Cho; Andrew C Belden; Donn Colby; Merlin Robb; Denise Hsu; Serena Spudich; Robert Paul; Sandhya Vasan; Lishomwa C Ndhlovu Journal: PLoS Pathog Date: 2021-08-13 Impact factor: 6.823
Authors: Rowan Saloner; Judith D Lobo; Emily W Paolillo; Laura M Campbell; Scott L Letendre; Mariana Cherner; Igor Grant; Robert K Heaton; Ronald J Ellis; Scott C Roesch; David J Moore Journal: AIDS Behav Date: 2021-12-08