Background: Overall prevalence of neurocognitive impairment (NCI) has been estimated as high even in the cART era. More recently, lower NCI prevalence has been found in MSM, suggesting that it may be previously overestimated. Aim of the study was to evaluate prevalence of HIV-associated neurocognitive disorders (HAND) and predictive factors in more recent years of cART impact.
Methods: Single-centre, retrospective, cross-sectional analysis of neurocognitive profile in HIV-infected cART-treated patients. All patients underwent neuropsychological assessment (NPA) by standardized battery of 14 tests on 5 different domains. People were classified as having HAND according to Frascati’s criteria. Chi-square for trend, and multivariable logistic regression were fitted.
Results: 569 consecutive HIV-infected cART-treated individuals from 2009 to 2014, contributing a total of 858 NPA tests, were included (male 82%; median age 48 years; MSMs 51%; HCV+ 15%; CD4 nadir >200 cell/ mm3 61%; current CD4 >350 cell/mm3 83%; HIV-RNA <40 c/mL 83%). At the time of NPA, 49% of patients were receiving a NNRTI-based, 32% a PIr-based, and 11% a NRTI-sparing regimen, for a median time of exposure to current regimen of 25 months (IQR 9-46). A cognitive complaint of memory loss, attention deficit or concentration difficulties was observed in 313 (36%) tested patients, whereas 545 (64%) were non-complaining. HAND prevalence was 48% in complaining (ANI=23%; MND=21%; HAD=4%) and 16% in non-complaining patients (ANI=12%; MND=4%; HAD=0). By calendar periods, prevalence of HAND in complaining was 50% in 2009/2010, 45% in 2011/2012 and 48% in 2013-2014 (P at chi square for trend=0.74). In non-complaining was 20%, 22% and 9%, respectively (P at chi square for trend=0.004). Factors associated to HAND by multivariable logistic regression are reported in Table.
Conclusions: In very late cART era, in a prevalent MSM population, HAND prevalence was close to 50% only in patients selected to NPA for a cognitive complaint. In people with no specific cognitive complaints, prevalence of HAND was confirmed as lower than previously detected, estimated as less than 10% in the more recent years. Higher CD4 count at NPA, higher CD4 nadir, a shorter time from HIV diagnosis and higher educational level were associated to a lower risk of NCI. Receiving a NRTI-sparing ART at cognitive assessment seems to be related to a lower risk of impaired cognition.