CD4 nadir and neurocognitive trajectories in people living with HIV.

Autor: Garabet R; Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA.; Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA., Dampier W; Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA.; Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA., Tillman S; Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA.; Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University, Philadelphia, PA, USA., Malone K; Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA.; Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University, Philadelphia, PA, USA., Szep Z; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Althoff A; Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University, Philadelphia, PA, USA., Pirrone V; Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA.; Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA.; Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA., Nonnemacher MR; Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA.; Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA.; Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA., Wigdahl B; Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA.; Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA.; Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA., Schultheis M; Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA., Devlin KN; Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA. knd52@drexel.edu.
Jazyk: angličtina
Zdroj: Journal of neurovirology [J Neurovirol] 2024 Aug; Vol. 30 (4), pp. 423-433. Date of Electronic Publication: 2024 Jun 10.
DOI: 10.1007/s13365-024-01217-8
Abstrakt: Human immunodeficiency virus-associated neurocognitive disorders persist in the combination antiretroviral therapy era. CD4 nadir is a well-established predictor of cognition cross-sectionally, but its impact on longitudinal neurocognitive (NC) trajectories is unclear. The few studies on this topic examined trajectories of global cognition, rather than specific NC domains. The current study examined CD4 nadir in relation to domain-specific NC decline. 132 HIV + adults from the Temple/Drexel Comprehensive NeuroHIV Center, Clinical and Translational Research Support Core Cohort were administered comprehensive NC assessments longitudinally, with last visit occurring an average of 12 years after CD4 nadir. Linear mixed models were used to examine CD4 nadir in relation to longitudinal NC trajectories in three empirically identified NC domains: speed/executive function (S/EF), visuospatial memory (VM), and verbal fluency (VF). CD4 nadir was associated with change in VF (p = 0.020), but not with S/EF or VM. Specifically, those with CD4 nadir < 200 demonstrated increasing VF over time (p = .002), whereas those with CD4 nadir > 200 demonstrated stable VF (p = .568), though these differing trajectories may partly reflect regression to the mean or differential practice effect. CD4 dynamics over time were analyzed as potential mechanisms for the identified associations, with mixed findings. While low CD4 nadir has been associated with weaker neurocognition among people living with HIV, the results of this study suggest that low CD4 nadir is not associated with ongoing decline a decade later. Nadir-related deficits in VF may be stable or even improve over time, possibly reflecting the beneficial cognitive effects of long-term treatment and immune reconstitution.
(© 2024. The Author(s).)
Databáze: MEDLINE
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