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Neurocognitive Impairment in the Combined Antiretroviral Therapy Era in a Romanian Cohort of Young Adults with Chronic HIV Infection.

Authors
  • Temereanca, Aura1, 2
  • Ene, Luminita3
  • Rosca, Adelina1, 2
  • Diaconu, Carmen C2
  • Luca, Anca3
  • Burlacu, Ruxandra3
  • Radoi, Roxana3
  • Bulacu-Talnariu, Adina3
  • Marcotte, Thomas D4
  • Achim, Cristian L4
  • Ruta, Simona1, 2
  • 1 Virology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. , (Oman)
  • 2 Viral Emerging Diseases Department, Ştefan S. Nicolau Institute of Virology, Bucharest, Romania. , (Oman)
  • 3 HIV/AIDS Department, Dr Victor Babes Hospital for Infectious and Tropical Diseases, Bucharest, Romania. , (Oman)
  • 4 Pathology Department, University of California at San Diego, Gilman, La Jolla, California.
Type
Published Article
Journal
AIDS Research and Human Retroviruses
Publisher
Mary Ann Liebert
Publication Date
Oct 08, 2019
Identifiers
DOI: 10.1089/AID.2019.0132
PMID: 31476875
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

HIV-associated neurocognitive disorders (HAND) continue to be reported even in patients with successful antiretroviral treatment. We investigated the prevalence of neurocognitive impairment and possible HIV-associated determinants of cognition in a Romanian cohort of young adults, parenterally infected with HIV during their first years of life. Two hundred fourteen treatment-experienced HIV-positive individuals [median age: 24 years, males: 48%, median duration on combined antiretroviral therapy (cART): 12 years] underwent standard immunologic and virological monitoring and antiretroviral resistance testing using pol gene sequencing in both plasma and, when available, cerebrospinal fluid (CSF) paired samples. Neurocognitive impairment was assessed using a comprehensive neuropsychological test battery, and a global deficit score (GDS) was calculated (cutoff ≥0.5). Cognitive impairment was detected in 35% of the study participants, without any association with sex, median age, CD4 cell count (actual or nadir), CSF and plasma viral load (actual or zenith), AIDS diagnosis, duration of HIV infection, and cART characteristics. Participants carrying resistant viruses tended to be more frequently cognitively impaired (p = 0.36), with a higher median GDS value (p = 0.06) compared with participants harboring wild-type HIV, although the figures did not reach statistical significance. No signs of virological compartmentalization were observed based on CSF versus plasma viral load and on the profile of pol sequences. A moderate rate of mild neurocognitive impairment is still present in young adults with chronic HIV infection acquired in early childhood despite successful cART, without any association with classic markers of HIV infection. New biomarkers reflecting persistent central nervous system inflammation and neuronal injury may be more relevant for the development of HAND.

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