Abstract
Background: HIV-associated neurocognitive disorder (HAND) may appear in patients with viral and immunological response to treatment and remain unnoticed during the initial stage of the infection. The goal of this study is to evaluate the development and/or progression of HAND in patients with undetectable viral load for more than ten years. Methods: We included adult HIV-infected patients who were under antiretroviral treatment and had undetectable plasma viral load for more than ten years (blips were included). These patients had already been subjected to neurocognitive evaluation five years previously. Demographic, clinical and analytical data were analysed. For the neurocognitive evaluation, the WAIS-III subtests (digit symbol coding and symbol search), trail making test (TMT) A and B, Stroop test and categorical verbal fluency (animals) tests were used. SPSS? version 22.0 for Windows was used for statistical analysis. Results: In this re-evaluation, performed 4.76 (±1.82) years after the first one, 9 (36%) patients showed deficits in processing speed (WAIS-III and TMT A), 8 (32%) executive function (TMT B and Stroop) and 12 (48%) verbal fluency. There were significant statistical differences between the past and current executive function tests (p = 0.029 and p = 0.01), highlighting worsening of deficits. No differences were found for the other tests. No association was found between deficit progression and the studied variables. Conclusions: Although not generally noticed on regular appointments, in this small population, worsening of executive function deficits (mental flexibility and divided attention) was found. Classical risk factors for HAND did not appear to interfere in its progression. Speed of information processing and categorical verbal fluency remained stable.
Highlights
Since the discovery of the human immunodeficiency virus (HIV) and the first descriptions of the acquired immunodeficiency syndrome (AIDS), more than 30 years ago [1] [2] [3], major advances in diagnosis and treatment were made
Several cross-sectional studies state that half of HIV-infected patients have some form of cognitive impairment [6] [7], and AIDS patients score consistently worse than healthy controls [8] [9]
Since the impact of antiretroviral therapy (ART) seems irrelevant related to HIV-associated neurocognitive disorder (HAND) development, we proposed to carry out the second neurocognitive evaluation in patients on ART with suppressed viral load for 10 years, assess their cognitive and functional evolution, and evaluate the impact of biological, psychological and social variables
Summary
Since the discovery of the human immunodeficiency virus (HIV) and the first descriptions of the acquired immunodeficiency syndrome (AIDS), more than 30 years ago [1] [2] [3], major advances in diagnosis and treatment were made. The spectrum of HAND is wide, so in 2007 the criteria of Frascati were established to distinguish three subclasses of increasing severity in terms of cognitive and functional status: asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia [12]. These disorders and their degree of impact are influenced by biological factors related to HIV and chronic infection neurodegeneration [13] [14] [15] [16], as well as psychological, demographic and social factors [17] [18] [19].
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