SUSTAINED COGNITIVE DECLINE IN HIV-INFECTION - RELATIONSHIP TO CD4+ CELL COUNT, PLASMA VIREMIA AND P24 ANTIGENEMIA

To determine the clinical and virological correlates of neuropsycholog ical test performance decline in HIV infection, we measured viral burd en in blood in 272 HIV-seropositive men without dementia in the Baltim ore arm of the Multicenter AIDS Cohort Study (MACS), These measures we re then related to neuropsychological (NP) decline, defined as a decli ne relative to prior best performance of 2.0 standard deviations or mo re on one or more neuropsychological tests. A short battery of NP test s (Mini-Screen Battery) was administered to all 272 men, NP test perfo rmance decline was identified in 53/272 (19.5%) of participants on the Mini-Screen Battery, Follow-up NP data were available for 204 partici pants who had undergone the Mini-Screen. The frequency of sustained NP test performance decline was 7.8% for the Mini-Screen Battery, A lowe r CD4+ cell count was weakly associated with sustained NP test perform ance decline, After adjustment for CD4+ cell count, hemoglobin, body m ass index, and presence of AIDS, none of the viral burden measures (p2 4 antigenemia, plasma viremia, quantitative culture) correlated with s ustained NP test performance decline, We conclude that these measures of blood HIV viral burden are not markers for NP decline, but that a l ower CD4+ cell count is.