Early Antiretroviral Therapy May Help Prevent Progressive Brain Injury in HIV

Patients with HIV had reduced brain volume and poorer cognitive performance but changes over time were similar to those in controls, according to research published in JAMA Neurology.

HIV-associated neurocognitive disorders (HAND) affect up to 40% of patients with HIV regardless of effective viral suppression. Although HAND is common, progressive worsening is not and it remains unclear what role viral suppression plays.

To detect evidence of ongoing brain atrophy changes in brain volumes, shown using magnetic resonance imaging (MRI) scans and neuroimaging processing methods, and cognitive function assessed with standard neurophysiological tests over 2 years were compared in HIV-positive individuals treated with combination antiretroviral therapy and aviremic with demographically similar HIV-negative controls.

HIV-positive participants (n=48) were selected from ongoing studies at the Clinical Trial Unit at Washington University in St Louis, Missouri from October 26, 2011, to March 1, 2016 and HIV-negative controls (n=31) from the surrounding community.

HIV-positive participants performed worse than controls on 6 neurophysiological tests, but only changes in scores from 1 of 6 tests (Trial Making Test Part A, –1.9 seconds per year, 95% CI, –3.8 to –0.02; P =.03) differed significantly. Cortical thickness and subcortical brain volumes were smaller in the HIV-positive group but changes over time did not significantly differ in the 2 groups.

These results support the idea that brain atrophy occurs early after seroconversion and maintaining aviremia can minimize injury. However, the researchers note several important limitations that require follow-up study. First, study design did not include testing of cardiovascular risk factors common to patients with HIV that are associated with cognitive deficits. 

Second, no comparisons can be made with patients with HIV with lesions or other comorbidities and finally no information on the functional limitations of daily living needed to categorize participants with respect to the HAND categories was collected.

Reference

Sanford R, Fellows LK, Ances BM, Collins L. Association of brain structure changes and cognitive function with combination antiretroviral therapy in HIV-positive individuals. [published online November 13, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.3036

This article originally appeared on Infectious Disease Advisor