HIV Infection and Treatment Are Not Risk Factors for Neurocognitive Impairment, Study Suggests
November 20, 2012
Having HIV does not seem to be associated with neurocognitive impairment (NCI), which includes declines in memory, concentration and mental ability, according to results from a recent French cohort study. Instead, more traditional risk factors, including aging, education level, anxiety, depression, cardiovascular disease and history of head injury, were associated with NCI.
We know NCI affects many individuals living with HIV, but existing studies looking into the reasons why have been limited to groups already experiencing some form of impairment. Therefore, researchers in France designed a study to investigate a broader sample of HIV-infected patients receiving routine HIV care.
The study followed 400 HIV-infected patients with a median age of 47 years; 79% were male. About 89% were on treatment, of whom 93% had a viral load below 500 copies/mL.
To test neurocognitive function, standardized tests were given by psychologists. Information regarding traditional risk factors for NCI was also gathered from medical records. Additionally, half of the patients went through a brain MRI scan to measure white and gray matter volumes.
The prevalence of NCI was 59%, which consisted of 21% asymptomatic NCI, 31% mild neurocognitive disorders (MND) and 7% HIV-associated dementia (HAD). Risk factors associated with MND and HAD were low level of education, previous AIDS-defining events, anxiety, depression and history of brain damage. HIV and antiretroviral treatment were not related risk factors, while lower gray matter volume was associated with NCI.
"Most of the cases were related to non-HIV-related determinants," comment the authors. "The high prevalence of NCI observed in our cohort was neither associated with incomplete viral suppression nor current nor nadir CD4 count. Furthermore, we did not find any association with the current cART [combination antiretroviral therapy] regimen." [...]
After controlling for confounding factors, the investigators found that a number of traditional risk factors were associated with an increased risk of impairment.
These included lower levels of education, a history of cardiovascular disease, high cholesterol, anxiety, depression, a history of neurological disease or trauma, and diagnosis with an AIDS-defining neurological disease. No HIV-related factor such as CD4 cell count, viral load, duration of infection with the virus, or use of antiretroviral therapy had a significant association with the risk of impairment.
When the investigators restricted their analysis to the 192 participants without anxiety, depression, a history of brain damage and who also had a higher level of education, they found that only 19% had symptomatic impairment. Restricting analysis further to people without a history of cardiovascular disease reduced the prevalence to just 10%.
While more research needs to be done to further assess NCI in people living with HIV, with these results, the researchers suggested the need for better screening and treatment of cardiovascular disease, anxiety and depression.
Warren Tong is the research editor for TheBody.com and TheBodyPRO.com.
Follow Warren on Twitter: @WarrenAtTheBody.
Copyright © 2012 Remedy Health Media, LLC. All rights reserved.
Comment by: Fred
Sat., Dec. 1, 2012 at 4:59 pm EST
I think that anyone who believes HIV and/or medications don't cause impairment should start by trying a couple weeks on Sustiva and then get back to me. With that said, some of the responses I've seen to this article, in these comments and real life, evokes the old cliche, "thou doth protest too much". My understanding is that the link between HIV and impairment is poorly understood at best, regardless of "the wealth of data we have about microglial cells". It's been observed in formats of better reasoning than the comments section here allows that huge swaths of poz and neg alike have a vested interest in making sure HIV is perceived as worse than it is. One obscure european study shouldn't exactly be getting reactions that are this passionate or numerous.
Comment by: Bill
Sun., Nov. 25, 2012 at 8:09 pm EST
This study confuses me. I have HIV mild neurocognitive impairment, to the extent that I am on disability. I can put together coherent thoughts, but just can't think on my feet. Learning is extremely difficult, impossible at times. But this article makes it sound that my issues aren't caused by HIV? The only thing my doctors have been able to tell me is that the jury is out as to whether this is caused by the virus or the meds. And the only things I can do is adhere to my med regimen and take care of myself - both things I do! AND, I can't find any resources for this, either support or informational... Very frustrating!
Comment by: Peter
Fri., Nov. 23, 2012 at 9:16 am EST
I don't understand why the headline of this article makes the claim that it does, when the article states that:
"The prevalence of NCI was 59%, which consisted of 21% asymptomatic NCI, 31% mild neurocognitive disorders (MND) and 7% HIV-associated dementia (HAD)."
Surely a 59% prevalence of neurocognitive impairment amongst the 400 HIV-infected patients means that HIV Infection and Treatment ARE risk factors for Neurocognitive Impairment!
Furthermore, the article goes on to state that "AIDS-defining neurological disease" is one of the factors "associated with an increased risk of impairment"!
In my own case, I know that taking Sustiva/Efavirenz completely screwed up my Central Nervous System so that I was deprived of sleep for nearly a year and experienced hellish nightmares nightly, and even though I am no longer on that drug my CNS is still somewhat screwed up and I have noted reduced or abnormal cognitive functioning.
Can we have a whole article on this issue, please?
Comment by: NOBLYN P.
Thu., Nov. 22, 2012 at 2:47 am EST
i have really been enligthen tanks, i have actually been a care giver to two positive young women who had neurocognitive impairment in the form of declined mental ability and have argued that it was as a result of their HIV status,because they got better just after they started the ARV. i now strongly belive it could have been as a result of depression or other health issues.
Comment by: Bruce Smith, MD, MPH
(Lilongwe, Malawi, SE Africa)
Thu., Nov. 22, 2012 at 1:09 am EST
Does 59% of the French general population across all adult ages have NCI? Where are the controls in this study? If only HIV-infected people are studied, then the design does not allow for HIV infection to be shown to be a causative factor or even an associated factor. While the fact that within the HIV-infected population studied nadir CD4 count was not associated with NCI is suggestive of the reported outcome, this study, as reported, cannot show that. In fact, HIV infection and some particular aspect of that in a sub-set of the infected population might still be a risk factor to NCI itself when joined with other more traditional factors such as education and previous head injury. Where was the study published so that we can look at the original article?
Comment by: William White
(Salt Lake City, Utah)
Wed., Nov. 21, 2012 at 4:37 pm EST
This is one study with no baseline neurocognitive testing, i.e. before infection. I have no doubt other risk factors play a roll but to say HiV and treatment are not "risk" factors is absurd given the wealth of data involving infection of astrocytes and microglial cells by HIV, and the tremendous number of side effects of our current anti viral drugs. Their, and your conclusion (your headline) is premature.
Comment by: rhiannon
Wed., Nov. 21, 2012 at 3:41 pm EST
HIV-Positive MSM Have Neurologic Disease Earlier Than HIV-Negatives
Author: Mark Mascolini
17 November 2012
HIV-positive men who have sex with men (MSM) on antiretroviral therapy (ART) had neurologic disease at a younger age than HIV-negative MSM at risk for HIV infection in the US Multicenter AIDS Cohort Study (MACS). Compared with the HIV-negative group, HIV-positive men had significantly higher rates of four types of neurologic disease, including dementia.
High rates of neurologic disease persist in HIV-positive people despite access to combination ART. MACS investigators conducted this study to compare incidence and patterns of neurologic disease in HIV-positive MACS members and HIV-negative men in the cohort. MACS is an ongoing prospective study of MSM in four US cities.
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