Neurocognitive performance enhanced by highly active antiretroviral therapy in HIV-infected women

Objective: To determine whether highly active retroviral therapy (HAART) is associated with better neurocognitive outcome overtime among HIV-infected women with severely impaired immune function. Methods: A semiannual neurocognitive examination on four tasks was administ ered: Color Trail Making, Controlled Oral Word Association, Grooved Pegboar d and Four-Word Learning. This protocol was initiated in the HIV Epidemiolo gical Research study (HERS) study when a woman's CD4 cell count fell to < 1 00 x 10(6) cells/l. Immune function (CD4), viral load status and depression severity (CESD) were also assessed semi-annually, along with an interview to determine medication intake and illicit drug use. Results: HAART was not available to any participant at the rime of enrollme nt (baseline), while 44% reported taking HAART at their most recent visit ( mean duration of HAART 36.3 +/- 12.6 months). HAART-treated women had impro ved neurocognitive performance compared with those not treated with HAART. Women taking HAART for 18 months or more showed the strongest neurocognitiv e performance with improved verbal fluency psychomotor and executive functi ons. These functions worsened among women not taking HAART. Substance abuse status, severity of depressive symptoms, age and educational revel did not influence the HAART treatment effects on neurocognitive performance. Neuro cognitive improvements were strongly associated with the magnitude of CD4 c ell count increases. Conclusions: HAART appeared to produce beneficial effect on neurocognitive functioning in HIV-infected women with severely impaired immune systems. Be nefits were greatest for women who reported receiving HAART for more than 1 8 months. (C) 2001 Lippincott Williams & Wilkins.