To investigate neuropsychological performance
(NP) during acute HIV infection
(AHI) before and after combination antiretroviraltherapy (cART).
Prospective study of Thai AHI participants examined at 3 and
6 months after initiation of cART.
Thirty-six AHI participants were evaluated pre-cART at
median 19 days since HIV exposure
and 3 and 6 months after cART with the Grooved Pegboard test, Color Trails 1
& 2 (CT1, CT2), and Trail Making Test A. Raw scores were standardized to
251 age- and education-matchedHIV-uninfected
Thais. To account for learning effects, change in NP performance was compared
with that of controls at 6 months. Analyses included multivariable regression,
nonparametric repeated measures analysis of variance, and Mann-Whitney U test.
Baseline NP scores for the AHI group were within normal
range (z-scores range: -0.26 to -0.13). NP performance improved on CT1, CT2,
and Trail Making Test A in the initial 3 months (P < 0.01) with no
significant change during the last 3 months. Only improvement in CT1 was
greater than that seen in controls at 6 months (P = 0.018). Participants who
performed >1 SD below normative means on ≥2 tests (n = 8) exhibited higher
baseline cerebrospinal fluid HIV RNA
(P = 0.047) and had no improvement after cART.
Most AHI individuals had normal NP performance, and early
cART slightly improved their psychomotor function. However, approximately 25%
had impaired NP performance, which correlated with higher cerebrospinal fluid HIV RNA, and these abnormalities were not reversed
by early cART possibly indicating limited reversibility of cognitive impairment in a subset of AHI individuals.
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By:
- 1*Yale University School of Medicine, New Haven, CT; †SEARCH, The Thai Red Cross AIDS Research Center, Bangkok, Thailand; ‡US Military HIVResearch Program, Walter Reed Army Institute of Research, Silver Spring, MD; §Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD; ‖University of California, San Francisco, CA; ¶Missouri Institute of Mental Health, University of Missouri, St. Louis, MO; #Yale Center for Analytical Sciences, New Haven, CT; and **HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand.
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