HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors

摘要: Combination antiretroviral therapy (CART) has greatly reduced medical morbidity and mortality with HIV infection, but high rates of HIV-associated neurocognitive disorders (HAND) continue to be reported. Because large HIV-infected (HIV+) uninfected (HIV−) groups have not been studied similar methods in the pre-CART CART eras, it is unclear whether changed prevalence, nature, clinical correlates HAND. We used comparable subject screening assessments classify impairment (NCI) + − participants from era (1988–1995; N = 857) (2000–2007; 937). Impairment rate increased successive disease stages (CDC A, B, C) both eras: 25%, 42%, 52% 36%, 40%, 45% era. In medically asymptomatic stage (CDC-A), NCI was significantly more common Low nadir CD4 predicted whereas degree current immunosuppression, estimated duration viral suppression CSF (on treatment) were related only pre-CART. Pattern also differed: had motor skills, cognitive speed, verbal fluency, involved memory (learning) executive function impairment. High mild persist at all despite improved immune reconstitution CART. The consistent association across eras suggests that earlier treatment prevent severe immunosuppression may help Clinical trials targeting HAND prevention should specifically examine timing ART initiation.