Neuropsychological Impairment in Acute HIV and the Effect of Immediate Antiretroviral Therapy

作者：Kore Idil; Ananworanich Jintanat; Valcour Victor; Fletcher James L K; Chalermchai Thep; Paul Robert; Reynolds Jesse; Tipsuk Som****; Ubolyam Sasiwimol; Rattanamanee Somprartthana; Jagodzinski Linda; Kim Jerome; Spudich Serena^*

来源：JAIDS: Journal of Acquired Immune Deficiency Syndromes , 2015, 70(4): 393-399.

DOI：10.1097/qai.0000000000000746

• HIV infection
• HIV-associated neurocognitive disorder
• neuropsychological tests
• mild cognitive impairment
• antiretroviral therapy

Objective:To investigate neuropsychological performance (NP) during acute HIV infection (AHI) before and after combination antiretroviral therapy (cART).
Design: Prospective study of Thai AHI participants examined at 3 and 6 months after initiation of cART.
Methods: Thirty-six AHI participants were evaluated pre-cART at median 19 days since HIV exposure and 3 and 6 months after cART with the Grooved Pegboard test, Color Trails 1 & 2 (CT1, CT2), and Trail Making Test A. Raw scores were standardized to 251 age- and education-matched HIV-uninfected Thais. To account for learning effects, change in NP performance was compared with that of controls at 6 months. Analyses included multivariable regression, nonparametric repeated measures analysis of variance, and Mann-Whitney U test.
Results: Baseline NP scores for the AHI group were within normal range (z-scores range: -0.26 to -0.13). NP performance improved on CT1, CT2, and Trail Making Test A in the initial 3 months (P < 0.01) with no significant change during the last 3 months. Only improvement in CT1 was greater than that seen in controls at 6 months (P = 0.018). Participants who performed >1 SD below normative means on 2 tests (n = 8) exhibited higher baseline cerebrospinal fluid HIV RNA (P = 0.047) and had no improvement after cART.
Conclusions: Most AHI individuals had normal NP performance, and early cART slightly improved their psychomotor function. However, approximately 25% had impaired NP performance, which correlated with higher cerebrospinal fluid HIV RNA, and these abnormalities were not reversed by early cART possibly indicating limited reversibility of cognitive impairment in a subset of AHI individuals.

• 出版日期2015-12-1