Objectives: Large unselected studies on representative samples of HIV-infected patients with a whole battery of neuropsychological tests and cerebral MRI scan are required to assess the frequency of neurocognitive impairment (NCI), the determinants of mild neurocognitive disorders (MNDs), or HIV-associated dementia (HAD) and the relationship between NCI and MRI scan findings.
Methods: Investigation of 400 consecutively enrolled HIV-1-infected adults from the ANRS CO3 Aquitaine Cohort, using standardized neurocognitive tests chosen to achieve consistency with Frascati's criteria. Half of the patients had a cerebral MRI scan allowing gray and white matter volume measurement. Factors associated with NCI were studied by logistic regression models.
Results: Median age of participants was 47 years, 79% were male and 89% received combination antiretroviral treatment (cART), of whom 93% had plasma HIV RNA below 500 copies/ml. Median CD4 cell count was 515 cells/μl. Prevalence of NCI was 59%, including 21% of asymptomatic NCI, 31% of MND, and 7% of HAD. A low level of education, prior neurologic AIDS-defining disorders event, anxiety, depressive symptoms, and prior history of brain damage were independently associated with MND or HAD, but neither HIV nor cART-related variables. The presence of NCI was significantly associated with lower gray matter fraction.
Interpretation: In this large unselected cohort, a high prevalence of symptomatic neurocognitive disorders was mainly related to its traditional determinants and associated with gray matter atrophy at early stages of the disease.
aINSERM, U897 & CIC-EC7; Université Bordeaux Segalen; Institut de Sante Publique, d’Epidémiologie et Développement (ISPED)
bCentre Hospitalier Universitaire (CHU) Bordeaux, Coordination régionale de la lutte contre l’infection à VIH (COREVIH)
cCHU Bordeaux, Services de médecine interne et maladies infectieuses
dINCIA, UMR-CNRS 5287, Université Bordeaux Segalen
fCHU Bordeaux, Fédération de maladies infectieuses et tropicales, Bordeaux
gCHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Pessac
hUniversité Bordeaux Segalen, EA 4136, Bordeaux, France.
Correspondence to Dr Fabrice Bonnet, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, CHU Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux cedex, France. Tel: +33 5 56 79 58 26; fax: +33 5 56 79 58 22; e-mail: firstname.lastname@example.org
Received 26 April, 2012
Revised 4 October, 2012
Accepted 5 October, 2012