Early cART, Viral Suppression May Minimize Brain Injury in HIV Patients

No significant neuropsychological decline during two-year period with combination antiretroviral therapy
No significant neuropsychological decline during two-year period with combination antiretroviral therapy

(HealthDay News) — HIV-positive individuals treated with combination antiretroviral therapy (cART) have poorer neuropsychological test scores than controls but no significant neuropsychological decline over time, according to a study published online Nov. 13 in JAMA Neurology.

Ryan Sanford, from McGill University in Canada, and colleagues conducted neuroimaging and neuropsychological assessments approximately two years apart among individuals in a case-control study. Data were included for 48 HIV-positive individuals who were aviremic and treated with cART and 31 demographically similar HIV-negative controls. 

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The researchers found that after adjustment for age, sex, and educational level, HIV-positive participants had poorer neuropsychological test scores on the Trail Making Test Part A (5.9 seconds), Trail Making Test Part B (27.3 seconds), Digit Symbol Substitution Task (−12.5 marks), Letter-Number Sequencing (−2.5 marks), Letter Fluency (−6.6 words), and Hopkins Verbal Learning Test-Revised immediate recall (−2.4 words) compared with controls. Between the groups, the only significant difference was seen in changes in Trail Making Test Part A. Compared with controls, HIV-positive individuals had smaller cortical thickness and subcortical volumes. Over time the changes in brain volume were similar between the groups.

"These findings support the hypothesis that brain injury due to HIV could occur principally during untreated infection," the authors write. "This finding suggests that early initiation of cART and full viral suppression may preserve long-term brain health."

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