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Persistence and Progression of HIV-associated Neurocognitive Impairment (NCI) in the Era of Combination Antiretroviral Therapy (CART) and the Role of Comorbidities: The CHARTER Study
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Reported by Jules Levin
5th IAS Capetown July 19-22 2009
Robert Heaton, Ph.D.1, Donald Franklin, B.S1., David Clifford, M.D.2 ,Steven Woods, Psy.D.1, Monica Rivera Mindt, Ph.D3,4, Ofilio Vigil, M.S.1,Michael Taylor, Ph.D.1, Thomas Marcotte, Ph.D.1, J. Hampton Atkinson, M.D.1, Igor Grant, M.D.1, for the CHARTER Group
OBJECTIVE
To examine the prevalence and predictors of HIV associated NCI in the
CART era, within an HIV+ sample reflective of clinic populations with
varying degrees of comorbidity.
BACKGROUND AND SIGNIFICANCE
CART has greatly reduced medical mordbidity and mortality in HIV, but there is
evidence that neurological complications remain common, manifested by HIV-associated neurocognitive disorders (HAND) and distal sensory polyneuropathy
Comorbid conditions (eg. other infections, drug abuse, head injury) are common in HIV+ populations and may affect the prevalence, severity, and progression of NCI
Although there may be a disconnect between the medical and neurological benefits of CART, lack of large-scale comprehensive neurological studies has made accurate estimates of the prevalence of HAND and its relationship to disease and treatment factors difficult
Table 1. Subject Characteristics displayed by 3 comorbidity classes
*based on ANOVA with post hoc t- or chi-square tests; + IADL = Independent activities of daily living
Table 2. Comorbidity Classifications
We're interested in attributing observed cognitive impairment to HIV as confidently as possible. Therefore, we stratify people based on having other conditions that can affect the brain so that we can identify those who are most likely to have HAND (i.e., those with minimal or at most moderate comorbidities) and those whose impairment we can't attribute to HIV with confidence (i.e., those with many or severe comorbidities).
RESULTS
Supported by NIH contract N01 MH22005 (CHARTER; PI: I. Grant). Participating sites include: Johns Hopkins University (J. McArthur); Mt. Sinai School of Medicine (S. Morgello & D. Simpson); University of California, San Diego (J.A. McCutchan); University of Texas Medical Branch, Galveston (B. Gelman); University of Washington, Seattle (A. Collier & C. Marra); Washington University, St. Louis (D. Clifford)
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