mental health AIDS

Fall 2007 Newsletter / Volume 9, Issue 1

HIV Assessment News

Neuropsychological Assessment

Italian investigators (Tozzi et al., 2007)

examined the prevalence of and risk factors for persistent NP [neuropsychological] deficits in a complete clinic population of [94] patients with HIV-related NCI [neurocognitive impairment] treated with HAART [highly active antiretroviral therapy]. ... [The investigators] found that 62.8% of patients persistently showed abnormal results on serial NP testing. ... [T]he overall 65-month probability of showing persistent NP deficits despite HAART was 53.0%. ... [The investigators] found an association of persistent NP deficits with lower education and with greater impairment at baseline in different cognitive abilities such as concentration and speed of mental processing, memory, and mental flexibility. ... [T]he baseline severity of the cognitive impairment ... was the strongest predictor of persistent NP deficits despite HAART. (pp. 178-179)

According to Tozzi and colleagues, "[t]he results of this study extend previous observations indicating that current HAART regimens are inadequate to treat HIV-related NCI. Although a reversal of NP deficits was observed in more than one third of subjects, nearly two thirds of patients showed persistent NP deficits despite more than 5 years of HAART" (pp. 179-180). Importantly, the investigators "found that CD4 cell count and plasma viral load at baseline and over time, virologic response to HAART, HIV disease stage, age, CDC stage, and risk category were not associated with persistent NP deficits[, although the role of antiretroviral adherence was not assessed in this study]. Thus, clinical and laboratory markers routinely used to assess the efficacy of [antiretroviral] treatment and disease progression are of no use in predicting the evolution of neurologic disease" (pp. 180-181). Drawing on these data, Tozzi and colleagues conclude that "patients with reversible NCI were much closer to normal performance at baseline. The association between the severity of NCI before HAART initiation and the persistence of NP deficits despite HAART makes a strong argument for the initiation of HAART as soon as NCI is diagnosed. As such, diagnostic studies for early detection of NP dysfunction should be considered in routine clinical practice in untreated patients" (p. 181).

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