Positive and sustained effects of highly active antiretroviral therapy on HIV-1-associated neurocognitive impairment

Objectives: To determine whether highly active antiretroviral therapy (HAAR T) is effective in HIV-associated neurocognitive impairment. Design: An open label, prospective, observational study. Methods: Since April 1996, 116 patients with advanced HIV infection, revers e transcriptase inhibitor (nRTI) experienced but protease inhibitor (PI) na ive, were screened for the presence of neurocognitive impairment. Ninety pa tients with confounding neurological illness, opportunistic infections or d rug abuse were excluded. The remaining 26 patients underwent comprehensive neuropsychological testing, and laboratory measures before, after 6 and aft er 15 months of treatment with one PI plus two nRTI. Results: The prevalence of neurocognitive impairment decreased from 80.8% ( baseline) to 50.0% (P < 0.05) (sixth month) and to 21.7% (P < 0.001) (15th month). Among the functions explored, the impairment of concentration and s peed of mental processing decreased from 65.4 to 21.7% (P < 0.01) and of me mory impairment from 50 to 8.7% (P < 0.01). Comparing baseline with the six th and 15th month raw scores, a statistically significant improvement was s een in measures exploring concentration and speed of mental processing (P < 0.05), mental flexibility (P < 0.05), memory (P < 0.05), fine motor functi ons (P < 0.05) and visuospatial and constructional abilities (P < 0.01). Af ter 6 months of HAART patients with a normal neuropsychological examination had lower mean plasma viraemia (2.95 versus 3.97 log copies/ml, P < 0.05) and greater mean log plasma HIV RNA changes from baseline (-1.84 versus -0. 83 log copies/ml, P < 0.05) than neuropsychologically impaired subjects. Conclusion: HAART produces a positive and sustained effect on neurocognitiv e impairment in HIV-infected patients. A reduction of plasma viral load was associated with the regression of neuropsychological test abnormalities. ( C) 1999 Lippincott Williams & Wilkins.