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doi: 10.1097/QAD.0b013e32835b1019
Clinical Science

Cognitive disorders in HIV-infected patients: are they HIV-related?

Bonnet, Fabricea,b,c; Amieva, Hélènea; Marquant, Fabiennea,b; Bernard, Charlotted,e; Bruyand, Mathiasa,b; Dauchy, Frédéric-Antoineb,f; Mercié, Patricka,b,c; Greib, Carineg; Richert, Lauraa; Neau, Didierf; Catheline, Gwenaelled; Dehail, Patrickb,h; Dabis, Francoisa,b; Morlat, Philippea,b,c; Dartigues, Jean-Françoisa; Chêne, Genevièvea,b; for the ANRS CO3 Aquitaine Cohort

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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.

© 2013 Lippincott Williams & Wilkins, Inc.


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