Early ART start to prevent later cognitive decline

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Individuals who start HIV treatment very soon after contracting the virus may be at lesser risk of later developing cognitive decline than other HIV-positive individuals. Researchers conducted a cross-sectional observational study of 26 males living with HIV who started antiretroviral (ARV) treatment during primary infection, had an undetectable viral load, and did not have certain neuro-psychiatric conditions.

HIV-positive people, on average, have a higher risk of cognitive decline than the general population. The mean age of the men in this study was 43. They had a median CD4 count of 828, a median lowest-ever CD4 count of 359, and had been on ARVs for a median 5.7 years. Only one of the participants, or 4% of the total, had cognitive impairment.

The researchers concluded that early HIV treatment may help protect against HIV-associated neurocognitive disorders.

Objective: To determine the prevalence of HIV-associated neurocognitive disorders (HAND) in HIV-infected participants who initiated combination antiretroviral therapy (cART) during primary infection.
Design: Cross-sectional observational study.
Methods: HIV-infected men without neuropsychiatric confounds who had initiated cART during primary infection were administered a neuropsychological battery as well as questionnaires evaluating depression and quality of life. Eligibility was determined by a medical examination with history and review of records.
Results: Twenty-six primarily non-Hispanic white (73%), male (100%) participants were enrolled and underwent neurocognitive assessment. Mean age was 43 (28–71) years, with a median of 17 years of education (13–24). Median current and nadir CD4+ T-cell counts were 828 (506–1411) and 359 (150–621) cells/μl. All participants had plasma HIV-1 RNA less than 50 copies/ml. Median duration of cART prior to enrolment was 5.7 years (2.2–9.9). Median global deficit score was 0.17 (0.00–0.60). Only one (4%) participant was impaired.
Conclusion: Rates of HAND in this cohort of HIV-infected men without comorbid conditions who initiated early cART are low. Our findings suggest a possible neuroprotective benefit of early cART and an important contribution of comorbidities to observed HAND prevalence.

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