Antiretroviral treatment initiation does not differentially alter neurocognitive functioning over time in youth with behaviorally acquired HIV.

TitleAntiretroviral treatment initiation does not differentially alter neurocognitive functioning over time in youth with behaviorally acquired HIV.
Publication TypePublication
Year of Publication2016
AuthorsNichols SL, Bethel J, Kapogiannis BG, Li T, Woods SP, E Patton D, Ren W, Thornton SE, Major-Wilson HO, Puga AM, Sleasman JW, Rudy BJ, Wilson CM, Garvie PA
Corporate AuthorsAdolescent Medicine Trials Network for HIV/AIDS Interventions
JournalJ Neurovirol
Volume22
Issue2
Pagination218-30
Date Published2016 Apr
ISSN1538-2443
KeywordsAdolescent, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Attention, CD4 Lymphocyte Count, Cognitive Dysfunction, Drug Administration Schedule, Executive Function, Female, HIV Infections, HIV-1, Humans, Male, Memory, Short-Term, Models, Statistical, Neuropsychological Tests, Prospective Studies, Psychomotor Performance, Time Factors, Viral Load, Young Adult
Abstract

<p>Although youth living with behaviorally acquired HIV (YLWH) are at risk for cognitive impairments, the relationship of impairments to HIV and potential to improve with antiretroviral therapy (ART) are unclear. This prospective observational study was designed to examine the impact of initiation and timing of ART on neurocognitive functioning in YLWH in the Adolescent Medicine Trials Network for HIV/AIDS Interventions. Treatment naïve YLWH age 18-24 completed baseline and four additional assessments of attention/working memory, complex executive, and motor functioning over 3 years. Group 1 co-enrolled in an early ART initiation study and initiated ART at enrollment CD4 >350 (n = 56); group 2 had CD4 >350 and were not initiating ART (n = 66); group 3 initiated ART with CD4 <350 (n = 59) per standard of care treatment guidelines at the time. Treatment was de-intensified to boosted protease inhibitor monotherapy at 48 weeks for those in group 1 with suppressed viral load. Covariates included demographic, behavioral, and medical history variables. Analyses used hierarchical linear modeling. All groups showed improved performance with peak at 96 weeks in all three functional domains. Trajectories of change were not significantly associated with treatment, timing of treatment initiation, or ART de-intensification. Demographic variables and comorbidities were associated with baseline functioning but did not directly interact with change over time. In conclusion, YLWH showed improvement in neurocognitive functioning over time that may be related to practice effects and nonspecific impact of study participation. Neither improvement nor decline in functioning was associated with timing of ART initiation or therapy de-intensification.</p>

DOI10.1007/s13365-015-0389-0
Alternate JournalJ. Neurovirol.
PubMed ID26463526
PubMed Central IDPMC4781894
Grant ListU01 HD040533 / HD / NICHD NIH HHS / United States
U01 HD040474 / HD / NICHD NIH HHS / United States
5 U01 HD40533 / HD / NICHD NIH HHS / United States
UM1 AI069415 / AI / NIAID NIH HHS / United States
U01 HD040499 / HD / NICHD NIH HHS / United States
U01 HD040470 / HD / NICHD NIH HHS / United States
5 U01 HD 40474 / HD / NICHD NIH HHS / United States