Patients with HIV may experience changes in cognition and brain structure soon after seroconversion, but effective treatment can prevent or minimize progressive brain injury, recent study findings suggest.
“The introduction of combination antiretroviral therapy (cART) has transformed HIV from a fatal disease to a chronic condition,” D. Louis Collins, PhD, professor of biomedical engineering and neurology and neurosurgery at McGill University in Montreal, and colleagues wrote in JAMA Neurology. “However, HIV-associated neurocognitive disorders (HAND) are still prevalent, affecting up to 40% of HIV-positive individuals despite effective viral suppression. The possible cause of this mild brain dysfunction that limits quality of life remains unclear.”
Collins and colleagues compared the brain function and structure of patients with HIV who were involved in an ongoing study at Washington University in St. Louis with demographically similar HIV-negative individuals they recruited from the St. Louis area. A total of 48 HIV-positive participants who were receiving stable cART and had undetectable viral loads (< 50 copies/mL) and 31 controls were included in the study.
Collins and colleagues evaluated the participants using eight standard tests recommended to assess HAND and used MRIs to measure each participant’s brain volume. Participants completed two testing and MRI sessions at least 1 1/2 years apart, with a mean time between visits of 2.1 years for the HIV group and 1.9 years for controls.
At baseline, patients with HIV had significantly poorer scores in six of eight neuropsychological tests and significantly smaller cortical thickness and subcortical volumes compared with controls, according to Collins and colleagues. But changes over the course of 2 years were similar between the two groups, they reported.
“These findings support the hypothesis that brain injury due to HIV could occur principally during untreated infection,” they concluded. “This finding suggests that early initiation of cART and full viral suppression may preserve long-term brain health. - by Gerard Gallagher
Disclosures: The authors report no relevant financial disclosures.