CROI Abstract Shows Drop in Neurocognitive Deficit Among PLWH

An abstract presented at this year’s Conference on Retroviruses and Opportunistic Infections (CROI) bore out the results of an Italian investigation into a potential link between persons living with HIV (PLWH) taking newer antiretroviral therapies and neurocognitive disorder prevalence.

A comparison of HIV-associated neurocognitive disorder (HAND) outcomes among persons living with HIV who either complained or did not complain they had HAND symptoms shows there was a marked decrease in overall prevalence of the condition.

Findings from 1365 study participants, attending National Institute for Infectious Diseases Lazzaro Spallanzani (in Rome, Italy, and 2383 neuropsychological assessment (NPA) tests from 2009-2011, 2012-2014, 2015-2017, and 2018-2020 were presented during the oral abstract session, “Is There a Role of Novel ART Regimens in the Declining Prevalence of HAND?” at this year’s Conference on Retroviruses and Opportunistic Infections.1

Frascati’s criteria were used to classify HAND, of which there are 3 progressive stages: asymptomatic neurocognitive impairment (ANI), HIV-associated mild neurocognitive disorder (MND), and HIV-associated dementia (HAD). Persons are classified with a stage following a 13-test evaluation of functions that include attention and working memory, mental processing speed, memory, and fine motor skills, as well as if their impairment is determined to not be from another condition (eg, head trauma or substance abuse).2

“HAND is still prevalent among PLWH,” the investigators wrote. “The aim of the study was to evaluate prevalence and predictors of HAND, including treatment-related factors, in a large cohort of PLWH over the last decade.”

Cognitive complaints were reported in 33% of the 2383 NPA tests, with the remaining not reporting complaints, and the overall prevalence of HAND was 22%. Breaking the HAND prevalence down further, most had ANI, followed by MND and HAD.

Eighty-two percent of the participants were male, 22% of the entire cohort had comorbid hepatitis C infection, 85% had an HIV-RNA level below 40 copies/mL, median (interquartile range) years of infection were 10 (4-20), median CD4 count was 600 (419-790) cells/mm3, nadir CD4 count was below 200 cells/mm3 in 35%, and median years of education were 13 (8-14).

Antiretroviral regimens comprised combination treatments of a nucleoside reverse transcriptase inhibitor (NRTI)/non-nucleoside reverse transcriptase inhibitor in 42%, a boosted protease inhibitor/NRTI in 19%, and an integrase strand transfer inhibitor (INSTI)/NRTI in 18%; dual regimens in 8% (4% of which were INSTI based); and dolutegravir in 8%.

Further analyzing the NPA test results, HAND was more than 3-fold prevalent in the tests bearing a cognitive complaint vs those with no complaint: 40% vs 13%. In addition, key differences were seen between the complaining and noncomplaining cohorts, respectively:

  • 78% vs 84% men
  • 40% vs 48% gay/bisexual men
  • 78% vs 89% with a viral load below 40 copies/mL
  • 51% vs 26% with nadir CD4 count was below 200 cells/mm3

Higher risk of HAND was associated with older age, less education, lower CD4 count, and comorbid HCV. Lower risk of was associated with an extra year of education, higher CD4 count, a recent NPA, and being on an integrase inhibitor–based antiretroviral treatment (ART) regimen or a dual regimen.

Overall, there was a decreasing trend of HAND between the first NPA (2009-2011) and the last NPA (2018-2020): 38% for all, 52% among those with cognitive complaints, and 23% among those with no neurocognitive complaints.

Although strengths of these finding are that they highlight how HAND has a multifactorial pathogenesis and that more recent ART regimens have greater efficacy and tolerability, the possibility of the findings overestimating HAND, because of the use of the Frascati criteria, remains a possible limitation.2

References

1. Mastrorosa I, Brita AC, Mondi A, et al. Is there a role of novel ART regimens in the declining prevalence of HAND? Presented at: Conference on Retroviruses and Opportunistic Infections; February 12-16, 2022; Virtual. Oral-11. https://www.croiconference.org/abstract/is-there-a-role-of-novel-art-regimens-in-the-declining-prevalence-of-hand/

2. Volny-Anne A. Have HIV-associated neurological disorders declined in people with HIV due to recent antiretrovirals? NAM aidsmap. Published February 22, 2022. Accessed February 24, 2022. https://www.aidsmap.com/news/feb-2022/have-hiv-associated-neurological-disorders-declined-people-hiv-due-recent