Yang Qu1, Andrea Weinstein2, Zheng Wang3, Yu Cheng1,3, Lawrence Kingsley4,5, Andrew Levine6, Eileen Martin7, Cynthia Munro8, Ann B Ragin9, Leah H Rubin8,9,10, Ned W Sacktor10, Eric C Seaberg11, James T Becker2,12,13. 1. Department of Statistics. 2. Department of Psychiatry. 3. Department of Biostatistics. 4. Department of Epidemiology, Graduate School of Public Health. 5. Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. 6. Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. 7. Department of Psychiatry, Rush University School of Medicine, Chicago, Illinois. 8. Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, Maryland. 9. Department of Radiology, Northwestern University, Evanston, Illinois. 10. Department of Neurology, The Johns Hopkins University School of Medicine. 11. Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland. 12. Department of Neurology. 13. Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Abstract
OBJECTIVE: To determine whether combination antiretroviral therapy (cART) initiation alters the trajectory of cognitive performance in HIV+ men, and whether cognition prior to cART predicts postcART function. DESIGN: Longitudinal cohort study. Multicenter AIDS Cohort Study. METHODS: From an initial set of 3701 men with complete neuropsychological data, men with HIV infection were initially matched with men without infection on cognitive status, race, age, and timeline (T0 defined as cART initiation). Propensity score matching was then used to match pairs on depressive symptoms at T0, education, T0 cognitive scores, and recruitment cohort. There were 506 matched pairs of infected and uninfected men in the final analysis. Mixed effect models were constructed to analyze the trajectories of cognitive functions and to test the effect of cART and HIV on cognitive functions over time. RESULTS: Performance in each cognitive domain did not change following the initiation of cART among HIV-infected men with prior impairment and was comparable to the performance of their matched uninfected men. However, among the infected men who were unimpaired prior to cART, motor function declined significantly faster than it did for uninfected controls. CONCLUSIONS: Cognitive dysfunction is persistent in HIV-infected men and cART does not alter the trajectory of cognitive decline in men who were impaired prior to effective therapy. This suggests that current cognitive impairment in HIV+ men results from a legacy effect, and from factors other than the HIV itself. Furthermore, motor skills may be uniquely vulnerable to the virus, cART, or age-related co-morbidities.
OBJECTIVE: To determine whether combination antiretroviral therapy (cART) initiation alters the trajectory of cognitive performance in HIV+ men, and whether cognition prior to cART predicts postcART function. DESIGN: Longitudinal cohort study. Multicenter AIDS Cohort Study. METHODS: From an initial set of 3701 men with complete neuropsychological data, men with HIV infection were initially matched with men without infection on cognitive status, race, age, and timeline (T0 defined as cART initiation). Propensity score matching was then used to match pairs on depressive symptoms at T0, education, T0 cognitive scores, and recruitment cohort. There were 506 matched pairs of infected and uninfected men in the final analysis. Mixed effect models were constructed to analyze the trajectories of cognitive functions and to test the effect of cART and HIV on cognitive functions over time. RESULTS: Performance in each cognitive domain did not change following the initiation of cART among HIV-infected men with prior impairment and was comparable to the performance of their matched uninfected men. However, among the infected men who were unimpaired prior to cART, motor function declined significantly faster than it did for uninfected controls. CONCLUSIONS: Cognitive dysfunction is persistent in HIV-infected men and cART does not alter the trajectory of cognitive decline in men who were impaired prior to effective therapy. This suggests that current cognitive impairment in HIV+ men results from a legacy effect, and from factors other than the HIV itself. Furthermore, motor skills may be uniquely vulnerable to the virus, cART, or age-related co-morbidities.
Authors: C A Carne; R S Tedder; A Smith; S Sutherland; S G Elkington; H M Daly; F E Preston; J Craske Journal: Lancet Date: 1985-11-30 Impact factor: 79.321
Authors: Jessica L Montoya; Jennifer Iudicello; Pariya L Fazeli; Suzi Hong; Michael Potter; Ronald J Ellis; Igor Grant; Scott L Letendre; David J Moore Journal: J Acquir Immune Defic Syndr Date: 2017-02-01 Impact factor: 3.731
Authors: Jessica L Montoya; Laura M Campbell; Emily W Paolillo; Ronald J Ellis; Scott L Letendre; Dilip V Jeste; David J Moore Journal: J Acquir Immune Defic Syndr Date: 2019-01-01 Impact factor: 3.731