Changes in neurocognitive performance in a cohort of patients treated withHAART for 3 years

Objectives: To describe changes in HIV-associated neurocognitive impairment in patients treated with highly active antiretroviral therapy (HAART) for at least 3 years. Methods: Prospective, observational study of comprehensive neuropsychologic (NP) testing, neurologic examination, and laboratory measures before HAART and after 6, 15 and 45 months of HAART, on 28 consecutive patients seen in our department since April 1996. Results: At baseline, 16 patients were neurocognitively impaired and 12 wer e not. Among the 16 impaired patients, 5 patients failed to meet the criter ia for impairment after 6 months and 9 patients after both 15 and 45 months of HAART, respectively. Statistically significant improvements (p less tha n or equal to .01) were seen in two of six measures exploring the concentra tion and speed of mental processing, two of three measures exploring mental flexibility, in one of five measures exploring memory, and in two of two m easures exploring fine motor functions. Unimpaired study subjects performed better than impaired ones in 10 of 17 measures at baseline, in eight of 17 after 6 months, in six of 17 after 15 months, and in seven of 17 after 45 months of HAART. Conclusions: During the course of HAART, patients experienced a positive an d sustained improvement in their neurocognitive performance. However, the p resence of 7 of 16 (43.7%) patients with neurocognitive impairment, and the persistence of statistically significant differences in the neurocognitive performance between impaired and unimpaired patients after more than 3 yea rs of HAART, suggests that ongoing HIV-related neurologic damage can occur even during potent antiretroviral treatment.