Compared to HIV monoinfection, HIV dual infection (DI) has been associated with decreased CD4 T-cell counts and increased viral loads. The same markers are also associated with the development of HIV-associated neurocognitive disorder (HAND), which continues to be a prevalent problem in the era of combination antiretroviral therapy (ART). We sought to determine the relationship between DI and HAND.
Participants on ART (N = 38) underwent deep sequencingoffour PCR-amplified HIVcoding regions derived from peripheral blood mononuclear cell (PBMC) DNA samples. Phylogenetic analyses were performedto evaluate whether two distinct viral lineages, i.e. DI, were present in the same individual. All study participants underwent neurocognitive, substance use, and neuromedical assessments at each study visit.
Of 38 participants, 9 (23.7%) had evidence of DI. Using clinical ratings, global neurocognitive impairment was identified in 21 (55%) participants, and multivariate analysis demonstrated a significant association between DI and impairment;OR (95%CI) = 18.3 (1.9,414.2), p = 0.028. Neurocognitive impairment was also associated with lower current (p = 0.028) and nadir (p = 0.043) CD4 T-cell counts.
Deep sequencing of HIV DNA populations in PBMC identified DI in nearly a quarter ofHIV-infected adultsreceiving ART, and DI was associated with HAND. Dual infection may contribute to the development of HAND, perhaps due to increased viral diversity. Further investigation is needed to determine how DI results in worse neurocognitive performance.