Prevalence of HIV-Associated Neurocognitive Disorders in the Multicenter AIDS Cohort Study

OBJECTIVE:

To evaluate the frequency of HIV-associated neurocognitive disorder (HAND) in HIV+ individuals and determine whether the frequency of HAND changed over 4 years of follow-up.

METHODS:

The Multicenter AIDS Cohort Study (MACS) is a prospective study of gay/bisexual men. Beginning in 2007, all MACS participants received a full neuropsychological test battery and functional assessments every 2 years to allow for HAND classification.

RESULTS:

The frequency of HAND for the 364 HIV+ individuals seen in 2007-2008 was 33% and for the 197 HIV+ individuals seen at all time periods during the 2007-2008, 2009-2010, and 2011-2012 periods were 25%, 25%, and 31%, respectively. The overall frequency of HAND increased from 2009-2010 to 2011-2012 (p = 0.048). Over the 4-year study, 77% of the 197 HIV+ individuals remained at their same stage, with 13% showing deterioration and 10% showing improvement in HAND stage. Hypercholesterolemia was associated with HAND progression. A diagnosis of asymptomatic neurocognitive impairment was associated with a 2-fold increased risk of symptomatic HAND compared to a diagnosis of normal cognition.

CONCLUSION:

HAND remains common in HIV+ individuals. However, for the majority of HIV+ individuals on combination antiretroviral therapy with systemic virologic suppression, the diagnosis of HAND is not a progressive condition over 4 years of follow-up. Future studies should evaluate longitudinal changes in HAND and specific neurocognitive domains over a longer time period.

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By:   Sacktor N1, Skolasky RL2, Seaberg E2, Munro C2, Becker JT2, Martin E2, Ragin A2, Levine A2, Miller E2.

• 1From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles. sacktor@jhmi.edu.
• 2From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles.
• Neurology. 2015 Dec 30. pii: 10.1212/WNL.0000000000002277
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