Objectives
Is it possible to live
without neurocognitive or neurological symptoms after being infected with HIV
for a very long time? These study patients with decades-long HIV infection in
Finland were observed in this follow-up study during three time periods:
1986–1990, in 1997 and in 2013.
Setting
Patients from greater
Helsinki area were selected from outpatient's unit of infectious diseases.
Participants
The study included 80
HIV patients. Patients with heavy alcohol consumption, central nervous system
disorder or psychiatric disease were excluded.
Primary and secondary outcome measures
The patients underwent
neurological and neuropsychological examinations, MRI of the brain and
laboratory tests, including blood CD4 cells and plasma HIV-1 RNA.
Neuropsychological examination included several measures: subtests of Wechsler
Adult Intelligence Scale, Wechsler Memory Scale-Revised, list learning, Stroop
and Trail-Making-B test. The Beck Depression Inventory and Fatigue Severity Scale
were also carried out. The obtained data from the three time periods were
compared with each other.
Results
Owing to high mortality
among the original 80 patients, eventually, 17 participated in all three
examinations performed between 1986 and 2013. The time from the HIV diagnosis
was 27 (23–30) years. Blood CD4 cells at the diagnosis were 610 (29–870)
cells/mm3, and the nadir CD4 168 (4–408) cells/mm3.
The time on combined antiretroviral treatment was 13 (5–17) years. 9 patients
suffered from fatigue, 5 had polyneuropathy and 3 had lacunar cerebral
infarcts. There was a subtle increase of brain atrophy in 2 patients. Mild
depressive symptoms were common. The neuropsychological follow-up showed
typical age-related cognitive changes. No HIV-associated dementia features were
detected.
Conclusions
Polyneuropathy, fatigue
and mild depression were common, but more severe neurological abnormalities
were absent. These long-term surviving HIV-seropositive patients, while on
best-available treatment, showed no evidence of HIV-associated neurocognitive
disorder in neuropsychological and neuroradiological evaluations.
Full article at: http://goo.gl/MF8ese
By:
1Department of Neurology, Helsinki
University Central Hospital, Helsinki, Finland
2Rehabilitation Foundation, Helsinki,
Finland
3Department of Radiology, Helsinki
University Central Hospital, Helsinki, Finland
4Neuroimmunology Unit, Medical School,
University of Tampere, Tampere, Finland
5Department of Infectious Diseases at
Aurora Hospital, Helsinki University Central Hospital, Helsinki, Finland
Correspondence to Dr T Heikinheimo; Email: if.suh@llennoc-omiehnikieh.uttret
More at: https://twitter.com/hiv_insight
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