Neurocognitive performance in individuals with lower preHAART CD4 nadir and durable virological suppression in Buenos Aires, Argentina
L. Collins1, M. Roca2, E. Gleichgerrcht2, M. Ceriotto1
1Grierson Hospital, Guernica, Argentina, 2INECO, Buenos Aires, Argentina
Background: HIV-associated neurocognitive disorders (HAND) remain prevalent in the HAART era. Performance on neurocognitive tests is influenced by educational level, ethnic background, age and gender.
Methods: This is a cross sectional observational analytic study conducted at a public hospital. Patients with < 250 CD4 nadir and durable-virological suppression, reporting no cognitive concerns (n = 19) and demographically matched seronegative controls (n = 16) were included. A comprehensive neuropsychological battery using culturally adapted norms and a standardized functional test (FAQ) were used. People with prior CNS infections, psychiatric conditions and drug or alcohol abuse were excluded. Statistic analysis included independent Student´s t test or U Mann Whitney tests when appropriate. Individual test scores were transformed into z scores to determine the number of cognitive domains affected and classify patients according to HAND-HNRC criteria.
Results: The group averages 38 in age (53% male) and 9 years in education. Significant differences were found between the groups on tasks of memory, verbal fluency, attention, executive function and visuoconstruction.
89% of the patients were classified as Asymptomatic Neurocognitive Impairment (ANI) without functional decline. 11% of the patients were moderate/severely impaired. Despite the cognitive impairment of last group, patients could not been classified as HIV-associated Mild Neurocognitive Disorder or HIV-Associated Dementia because the lack of functional decline.
Significant correlation were observed between tasks of memory; verbal fluency and % CD4 nadir.
Conclusions: Neurocognitive assessment conducted in this patient group allows saying that HAND seems to occur even in patients with virological suppression and low preHAART CD4 nadir. The discordance between cognitive and functional impairment could be due to cultural differences that are not captured by the test used. This difficulty could affect the classification of patients according to HAND -HNRC criteria.
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