HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy

CHARTER Study

Dados Bibliográficos

ID23314942
AutoresRobert K Heaton (0000-0001-8786-7480, Johns Hopkins University), David B Clifford (0000-0001-5719-1555, Johns Hopkins University), Donald Franklin (0000-0002-6639-8686, Johns Hopkins University), D R Franklin (From the University of California (R.K.H., D.R.F., S.P.W., C.A., F.V., R.J.E., S.L.L., T.D.M., J.H.A., O.R.V., M.J.T., J.A.M., I.A., A.G., C.F.-N., T.L.J., I.G.), San Diego; University of California (J.W.), San Francisco; Washington University (D.B.C.), St. Louis, MO; Mount Sinai School of Medicine (M.R.-M., S.M., D.M.S.), New York, NY; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas Medical Branch (B.B.G.), Galveston; and Johns Hopkins University (J.C.M.), Baltimore, MD.), Steven Paul Wood (0000-0001-6873-5722, Johns Hopkins University), S P Woods (From the University of California (R.K.H., D.R.F., S.P.W., C.A., F.V., R.J.E., S.L.L., T.D.M., J.H.A., O.R.V., M.J.T., J.A.M., I.A., A.G., C.F.-N., T.L.J., I.G.), San Diego; University of California (J.W.), San Francisco; Washington University (D.B.C.), St. Louis, MO; Mount Sinai School of Medicine (M.R.-M., S.M., D.M.S.), New York, NY; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas Medical Branch (B.B.G.), Galveston; and Johns Hopkins University (J.C.M.), Baltimore, MD.), Christopher F Ake (Johns Hopkins University), C Ake (From the University of California (R.K.H., D.R.F., S.P.W., C.A., F.V., R.J.E., S.L.L., T.D.M., J.H.A., O.R.V., M.J.T., J.A.M., I.A., A.G., C.F.-N., T.L.J., I.G.), San Diego; University of California (J.W.), San Francisco; Washington University (D.B.C.), St. Louis, MO; Mount Sinai School of Medicine (M.R.-M., S.M., D.M.S.), New York, NY; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas Medical Branch (B.B.G.), Galveston; and Johns Hopkins University (J.C.M.), Baltimore, MD.), Florin Vaida (0000-0002-2256-4611, Johns Hopkins University), Ronald J Ellis (0000-0003-4931-752X, Johns Hopkins University), Scott Letendre (0000-0003-3490-4975, Johns Hopkins University), S L Letendre (From the University of California (R.K.H., D.R.F., S.P.W., C.A., F.V., R.J.E., S.L.L., T.D.M., J.H.A., O.R.V., M.J.T., J.A.M., I.A., A.G., C.F.-N., T.L.J., I.G.), San Diego; University of California (J.W.), San Francisco; Washington University (D.B.C.), St. Louis, MO; Mount Sinai School of Medicine (M.R.-M., S.M., D.M.S.), New York, NY; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas Medical Branch (B.B.G.), Galveston; and Johns Hopkins University (J.C.M.), Baltimore, MD.), Thomas D Marcotte (0000-0002-3039-6400, Johns Hopkins University), J Hampton Atkinson (0000-0001-6342-2591, Johns Hopkins University), Monica Rivera Mindt (0000-0001-6350-321X, Johns Hopkins University), M Rivera-Mindt (From the University of California (R.K.H., D.R.F., S.P.W., C.A., F.V., R.J.E., S.L.L., T.D.M., J.H.A., O.R.V., M.J.T., J.A.M., I.A., A.G., C.F.-N., T.L.J., I.G.), San Diego; University of California (J.W.), San Francisco; Washington University (D.B.C.), St. Louis, MO; Mount Sinai School of Medicine (M.R.-M., S.M., D.M.S.), New York, NY; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas Medical Branch (B.B.G.), Galveston; and Johns Hopkins University (J.C.M.), Baltimore, MD.), Ofilio Vigil (Johns Hopkins University), O R Vigil (From the University of California (R.K.H., D.R.F., S.P.W., C.A., F.V., R.J.E., S.L.L., T.D.M., J.H.A., O.R.V., M.J.T., J.A.M., I.A., A.G., C.F.-N., T.L.J., I.G.), San Diego; University of California (J.W.), San Francisco; Washington University (D.B.C.), St. Louis, MO; Mount Sinai School of Medicine (M.R.-M., S.M., D.M.S.), New York, NY; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas Medical Branch (B.B.G.), Galveston; and Johns Hopkins University (J.C.M.), Baltimore, MD.), Michael Taylor (0000-0002-3473-3478, Johns Hopkins University), M J Taylor (0000-0002-3796-0836, From the University of California (R.K.H., D.R.F., S.P.W., C.A., F.V., R.J.E., S.L.L., T.D.M., J.H.A., O.R.V., M.J.T., J.A.M., I.A., A.G., C.F.-N., T.L.J., I.G.), San Diego; University of California (J.W.), San Francisco; Washington University (D.B.C.), St. Louis, MO; Mount Sinai School of Medicine (M.R.-M., S.M., D.M.S.), New York, NY; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas Medical Branch (B.B.G.), Galveston; and Johns Hopkins University (J.C.M.), Baltimore, MD.), Ann C Collier (0000-0001-5673-0422, Johns Hopkins University), Christina M Marra (0000-0001-9313-2800, Johns Hopkins University), Benjamin B Gelman (Johns Hopkins University), Justin C McArthur (0000-0002-3512-771X, Johns Hopkins University), Susan Morgello (0000-0001-7729-245X, Johns Hopkins University), David M Simpson (0000-0001-9072-5088, Johns Hopkins University), J Allen McCutchan (0000-0001-9583-4531, Johns Hopkins University), Ian Abramson (Johns Hopkins University), Anthony Gamst (Johns Hopkins University), Christine Fennema‐Notestine (0000-0002-6527-6361, Johns Hopkins University), C Fennema-Notestine (From the University of California (R.K.H., D.R.F., S.P.W., C.A., F.V., R.J.E., S.L.L., T.D.M., J.H.A., O.R.V., M.J.T., J.A.M., I.A., A.G., C.F.-N., T.L.J., I.G.), San Diego; University of California (J.W.), San Francisco; Washington University (D.B.C.), St. Louis, MO; Mount Sinai School of Medicine (M.R.-M., S.M., D.M.S.), New York, NY; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas Medical Branch (B.B.G.), Galveston; and Johns Hopkins University (J.C.M.), Baltimore, MD.), Terry L Jernigan (0000-0002-2011-9370, Johns Hopkins University), J Wong (0000-0002-4771-361X, From the University of California (R.K.H., D.R.F., S.P.W., C.A., F.V., R.J.E., S.L.L., T.D.M., J.H.A., O.R.V., M.J.T., J.A.M., I.A., A.G., C.F.-N., T.L.J., I.G.), San Diego; University of California (J.W.), San Francisco; Washington University (D.B.C.), St. Louis, MO; Mount Sinai School of Medicine (M.R.-M., S.M., D.M.S.), New York, NY; University of Washington (A.C.C., C.M.M.), Seattle; University of Texas Medical Branch (B.B.G.), Galveston; and Johns Hopkins University (J.C.M.), Baltimore, MD.), Igor Grant (Johns Hopkins University)
Ano2010
Volume75
Fascículo23
Páginas2087-2096
Data de publicação2010-12-07
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoNeurology (JOURNAL)
Identificadores do periódicoISSN: 0028-3878 • E-ISSN: 1526-632X
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1212/wnl.0b013e318200d727
PMID21135382
PMCIDPMC2995535
OpenAlexW2137321682
IdiomaEN
Citações recebidas98
Referências citadas28

OBJECTIVES: This is a cross-sectional, observational study to determine the frequency and associated features of HIV-associated neurocognitive disorders (HAND) in a large, diverse sample of infected individuals in the era of combination antiretroviral therapy (CART). METHODS: A total of 1,555 HIV-infected adults were recruited from 6 university clinics across the United States, with minimal exclusions. We used standardized neuromedical, psychiatric, and neuropsychological (NP) examinations, and recently published criteria for diagnosing HAND and classifying 3 levels of comorbidity (minimal to severe non-HIV risks for NP impairment). RESULTS: Fifty-two percent of the total sample had NP impairment, with higher rates in groups with greater comorbidity burden (40%, 59%, and 83%). Prevalence estimates for specific HAND diagnoses (excluding severely confounded cases) were 33% for asymptomatic neurocognitive impairment, 12% for mild neurocognitive disorder, and only 2% for HIV-associated dementia (HAD). Among participants with minimal comorbidities (n = 843), history of low nadir CD4 was a strong predictor of impairment, and the lowest impairment rate on CART occurred in the subset with suppressed plasma viral loads and nadir CD4 ≥200 cells/mm(3) (30% vs 47% in remaining subgroups). CONCLUSIONS: The most severe HAND diagnosis (HAD) was rare, but milder forms of impairment remained common, even among those receiving CART who had minimal comorbidities. Future studies should clarify whether early disease events (e.g., profound CD4 decline) may trigger chronic CNS changes, and whether early CART prevents or reverses these changes.

Cart · Cognition · Comorbidity · Dementia · Disease · Neurocognitive · Psychiatry · Cytomegalovirus and herpesvirus research · HIV Research and Treatment · Internal Medicine · Medicine · Tryptophan and brain disorders · Pediatrics