Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Better executive function is independently associated with full HIV suppression during combination therapy

Anderson, Albert M.a; Pérez-Santiago, Josuéb,c; Zheng, Ziduod; Huang, Eugened; Franklin, Donaldb; Iudicello, Jenniferb; Moore, David J.b; Ellis, Ronald J.e; Heaton, Robert K.b; Letendre, Scott L.b,f

doi: 10.1097/QAD.0000000000002348

Objective: HIV-associated neurocognitive impairment continues to be prevalent and clinically relevant. We examined the relationship between neurocognition and full plasma HIV RNA suppression among study participants over a 15-year period at a large research program.

Design/methods: We analyzed the combined prospective studies of the HIV Neurobehavioral Research Program at the University of California at San Diego. Participants were eligible for analysis if on three drug combination antiretroviral therapy with comprehensive neuropsychological testing results. Participants who reported recent nonadherence were excluded. The primary outcome was plasma HIV RNA of 50 copies/ml or less. Generalized estimating equation was used to assess for associations with full virologic suppression taking into account longitudinal visits.

Results: There were 1943 participants at baseline, of whom 69.4% had plasma HIV RNA of 50 copies/ml or less. Participants with full suppression were slightly older, less likely to abuse cocaine, and had significantly better executive function. Multivariate analysis with incorporation of longitudinal visits (total = 5555) confirmed current cocaine abuse to be strongly associated with lack of virologic suppression (odds ratio = 0.45, 95% confidence interval = 0.31–0.63). In contrast, increasing age, increasing years of HIV infection, and increasing executive function (odds ratio = 1.18 for T score change of 10, 95% confidence interval = 1.07–1.30) were associated with full virologic suppression. Lack of virologic suppression at baseline was associated with a significant subsequent decline in executive function.

Conclusion: In a 15-year research cohort of almost 2000 HIV-infected individuals on combination antiretroviral therapy, better executive function was associated with full virologic suppression, possibly as a result rather than a cause.

aDepartment of Medicine, Emory University School of Medicine, Atlanta, Georgia

bDepartment of Psychiatry, University of California at San Diego School of Medicine, La Jolla, California, USA

cUniversity of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico

dDepartment of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia

eDepartment of Neurosciences

fDepartment of Medicine, University of California at San Diego School of Medicine, San Diego, California, USA.

Correspondence to Albert M. Anderson, MD, MHS, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. E-mail:

Received 15 March, 2019

Revised 8 July, 2019

Accepted 24 July, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.