HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study
| Autor: | R K, Heaton, D B, Clifford, D R, Franklin, S P, Woods, C, Ake, F, Vaida, R J, Ellis, S L, Letendre, T D, Marcotte, J H, Atkinson, M, Rivera-Mindt, O R, Vigil, M J, Taylor, A C, Collier, C M, Marra, B B, Gelman, J C, McArthur, S, Morgello, D M, Simpson, J A, McCutchan, I, Abramson, A, Gamst, C, Fennema-Notestine, T L, Jernigan, J, Wong, I, Grant, Mengesha, Teshome |
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| Rok vydání: | 2010 |
| Předmět: |
Male
Pediatrics HIV Infections Observation Neuropsychological Tests HIV-associated neurocognitive disorder Disability Evaluation Models Antiretroviral Therapy Highly Active Activities of Daily Living Neurologic Examination Cross-Over Studies Cognitive disorder Articles Statistical Middle Aged Infectious Diseases Mental Health 6.1 Pharmaceuticals HIV/AIDS Cognitive Sciences Female medicine.symptom Infection Viral load Algorithms Cart Adult medicine.medical_specialty Clinical Sciences Antiretroviral Therapy Enzyme-Linked Immunosorbent Assay Asymptomatic Clinical Research Behavioral and Social Science Acquired Cognitive Impairment medicine Dementia Humans Highly Active Retrospective Studies Psychiatric Status Rating Scales Neurology & Neurosurgery Models Statistical business.industry Neurosciences Evaluation of treatments and therapeutic interventions medicine.disease Comorbidity Brain Disorders CHARTER Group Physical therapy Neurology (clinical) business Cognition Disorders Neurocognitive |
| Zdroj: | Heaton, RK; Clifford, DB; Franklin, DR; Woods, SP; Ake, C; Vaida, F; et al.(2010). HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: Charter Study. Neurology, 75(23), 2087-2096. doi: 10.1212/WNL.0b013e318200d727. UC San Diego: Retrieved from: http://www.escholarship.org/uc/item/2147b649 Neurology, vol 75, iss 23 |
| ISSN: | 1526-632X |
| DOI: | 10.1212/WNL.0b013e318200d727. |
| Popis: | Objectives: This is a cross-sectional, observational study to determine the frequency and associated features of HIV-associated neurocognitive disorders (HAND) in a large, diverse sample of infected individuals in the era of combination antiretroviral therapy (CART). Methods: A total of 1,555 HIV-infected adults were recruited from 6 university clinics across the United States, with minimal exclusions. We used standardized neuromedical, psychiatric, and neuropsychological (NP) examinations, and recently published criteria for diagnosing HAND and classifying 3 levels of comorbidity (minimal to severe non-HIV risks for NP impairment). Results: Fifty-two percent of the total sample had NP impairment, with higher rates in groups with greater comorbidity burden (40%, 59%, and 83%). Prevalence estimates for specific HAND diagnoses (excluding severely confounded cases) were 33% for asymptomatic neurocognitive impairment, 12% for mild neurocognitive disorder, and only 2% for HIV-associated dementia (HAD). Among participants with minimal comorbidities (n = 843), history of low nadir CD4 was a strong predictor of impairment, and the lowest impairment rate on CART occurred in the subset with suppressed plasma viral loads and nadir CD4 ≥200 cells/mm3(30% vs 47% in remaining subgroups). Conclusions: The most severe HAND diagnosis (HAD) was rare, but milder forms of impairment remained common, even among those receiving CART who had minimal comorbidities. Future studies should clarify whether early disease events (e.g., profound CD4 decline) may trigger chronic CNS changes, and whether early CART prevents or reverses these changes. © 2010 by AAN Enterprises, Inc. All rights reserved. |
| Databáze: | OpenAIRE |
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