HIV Associated Neurocognitive Impairment in Diverse Resource Limited Settings.

Background: Neurocognitive impairment remains a common complication of HIV despite effective antiretroviral therapy (ART). We previously reported improved neurocognitive functioning with ART initiation in seven resource limited settings (RLS) countries for HIV+ participants from AIDS Clinical Trials Group (ACTG) 5199 (International Neurological Study (INS)). Here we apply normative data from the International Neurocognitive Normative Study (INNS) to INS, to provide previously unknown rates of neurocognitive impairment.

Methods: A5199, INS assessed neurocognitive and neurological performance within a randomized clinical trial with 3 arms, containing WHO first line recommended ART regimens (ACTG 5175; PEARLS). ACTG 5271, INNS collected normative comparison data on 2400 high-risk HIV negatives from 10 voluntary counseling and testing (VCT) sites aligned with INS. Normative comparison data were used to create impairment ratings for HIV+ participants in INS; associations were estimated using generalized estimating equations.

Results: Among 860 HIV+ adults enrolled in ACTG 5199, 55% had no neurocognitive impairment at baseline. Mild neurocognitive impairment was found in 25%, moderate in 17% and severe in 3% of participants. With the initiation of ART, the estimated odds of impairment was reduced 12% (95% CI: 9%, 14%) for every 24 weeks (p<.0001) on ART. Mild impairment dropped slightly, and then remained at about 18% out to week 168.

Conclusions: Almost half of HIV+ participants had neurocognitive impairment at baseline before ART, based on local norms. With ART initiation, there were significant overall reductions in neurocognitive impairment over time, especially in those with moderate and severe impairments.