HIGHLY-ACTIVE ANTIRETROVIRAL TREATMENT IN HIV-INFECTION - BENEFITS FOR NEUROPSYCHOLOGICAL FUNCTION

Objectives: To determine whether highly active antiretroviral therapy (HAART) is associated with reduced HIV-associated neuropsychological i mpairment. Design: Cross-sectional analysis in a natural history study of adaptation to HIV/AIDS. Method: A sample of 130 homo-/bisexual men with HIV/AIDS (mean age, 41 years; 42% non-white) were evaluated with a neuropsychological battery assessing attention, concentration, psyc homotor speed, learning, memory and executive function. Subjects takin g HAART were compared with those not taking HAART on demographics, CD4 cell count, viral load, scores on individual neuropsychological tests and proportion with neuropsychological impairment. Results: Sixty-nin e (53%) subjects were taking HAART, and 48 (37%) were neuropsychologic ally impaired. Subjects taking HAART had lower mean CD4 cell counts th an those not taking HAART (254 versus 342 x 10(6)/l; P < 0.05), althou gh they were more likely to have undetectable viral load (42 versus 20 %; P < 0.01) and were less likely to be neuropsychologically impaired (22 versus 54%; P < 0.0001). Subjects taking HAART performed significa ntly better on tests of attention, concentration, learning, memory, an d psychomotor speed. After excluding subjects with potential non-HIV c onfounders of neuropsychological function, those without neuropsycholo gical impairment had significantly lower mean viral load levels and we re more likely to have undetectable viral load than those with impairm ent. Conclusion: These preliminary findings suggest that HAART benefit s neuropsychological function through the reduction of viral load. (C) 1998 Lippincott-Raven Publishers.