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Neurocognitive Symptoms and Impairment in an HIV Community Clinic

Published online by Cambridge University Press:  02 December 2014

D.H. Kim ,
C. Power ,
M.J. Gill ,
D.L. Jewison ,
G.R. Milner  and
S.B. Rourke
D.H. Kim
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary AB
C. Power
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary AB Department of Microbiology and Infectious Diseases, University of Calgary, Calgary AB Southern Alberta Clinic, Calgary AB
M.J. Gill
Affiliation:
Department of Microbiology and Infectious Diseases, University of Calgary, Calgary AB Southern Alberta Clinic, Calgary AB
D.L. Jewison
Affiliation:
Southern Alberta Clinic, Calgary AB
G.R. Milner
Affiliation:
Southern Alberta Clinic, Calgary AB
S.B. Rourke
Affiliation:
Department of Psychiatry, University of Toronto, Toronto ON, Canada
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Abstract

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Background:

Neurocognitive impairment is a frequent complication of HIV infection and heralds a poor survival prognosis. With the availability of highly active antiretroviral therapy (HAART), survival times for HIV-infected patients have markedly increased although the effects of HAART on the prevalence of neurocognitive impairment remain uncertain.

Objective:

To determine the relationship between self-reported neurocognitive symptoms and neuropsychological (NP) performance together with the impact of HAART among HIV-infected patients.

Methods:

A cross-sectional study was performed in which patients without previously documented neurocognitive impairment attending an HIV community clinic were questioned about neurocognitive symptoms and a NP test battery was administered.

Results:

Of the eighty-three patients examined, neurocognitive symptoms were reported by 34% of patients and were associated with a shorter duration of HAART and higher viral loads. Patients reporting neurocognitive symptoms were also more likely to exhibit impaired NP performance (p<0.005) with NP impairment being detected in 46% of all patients examined (12% with HIV-associated dementia). Neuropsychological impairment was directly correlated with age (p<0.001), plasma viral load (p<0.005) and inversely correlated with the number of prescribed antiretroviral drugs (p<0.01).

Conclusion:

These results suggest that neurocognitive symptoms are predictive of impaired NP performance and that NP impairment remains a frequent finding among older patients with higher viral loads. An increased number of antiretroviral drugs may be neuroprotective.

Résumé:

RÉSUMÉ:Introduction:

Le déficit neurocognitif est une complication fréquente de l'infection par le VIH et comporte un mauvais pronostic quant à la survie. Avec l'arrivée de la thérapie antirétrovirale hautement efficace (HAART), la survie des patients infectés par le VIH a augmenté de façon appréciable, bien que l'influence de HAART sur la prévalence du déficit neurocognitif demeure inconnue. Objectif: Déterminer la relation entre les symptômes neurocognitifs rapportés par les patients et la performance neuropsychologique (NP) ainsi que l'impact de HAART chez les patients infectés par le VIH.

Méthodes:

Dans cette étude transversale, on a questionné des patients d'une clinique communautaire anti-VIH sans déficit neurocognitif documenté sur leurs symptômes neurocognitifs et on leur a administré une batterie de tests NP.

Résultats:

Parmi les quatre-vingt-trois patients examinés, des symptômes neurocognitifs ont été rapportés par 34% et ils étaient associés à une administration plus brève de HAART et à une charge viral plus élevée. Les patients qui rapportaient des symptômes neurocognitifs étaient également plus susceptibles d'avoir une performance NPaltérée (p < 0.005); une altération NPa été détectée chez 46% de tous les patients examinés (démence associée au VIH chez 12%). Le déficit NPétait directement corrélé à l'âge (p < 0.001), la charge virale plasmatique (p < 0.005) et inversement corrélé au nombre de médicaments antirétroviraux prescrits (p < 0.01).

Conclusions:

Ces résultats suggèrent que les symptômes neurocognitifs sont indicateurs d'une performance NP altérée et que l'altération NP demeure une constatation fréquente chez les patients plus âgés qui ont une charge virale plus élevée. Un nombre croissant de médicaments antirétroviraux puissent être neuroprotecteurs.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 28 , Issue 3 , August 2001 , pp. 228 - 231
Copyright
Copyright © The Canadian Journal of Neurological 2001

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