AIDS (London, England) 2017 05 03() doi 10.1097/QAD.0000000000001523
Despite treatment with virologically suppressive antiretroviral therapy (ART), neurocognitive impairment may persist or develop de novo in aging HIV-infected individuals. We evaluated advancing age as a predictor of neurocognitive impairment in a large cohort of previously ART-naïve individuals on long-term ART DESIGN:: The AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trials (ALLRT) was a prospective cohort study of HIV-infected individuals originally enrolled in randomized ART trials. This analysis examined neurocognitive outcomes ≥2 years after ART initiation.
All participants underwent annual neurocognitive testing consisting of Trail making A and B, the WAIS-R Digit Symbol and Hopkins Verbal Learning Tests. Uni- and multi-variable repeated measures regression models evaluated factors associated with neurocognitive performance. Predictors at parent study entry (ART naïve) included entry demographics, smoking, injection drug use, hepatitis B surface antigen, hepatitis C virus serostatus, history of stroke, ART regimen type, pre-ART nadir CD4 and plasma viral load (PVL) and as well as time-updated PVL and CD4.
The cohort comprised 3,313 individuals with median pre-ART age of 38 years, 20% women; 36% Black, non-Hispanic; 22% Hispanic. Virologic suppression was maintained at 91% of follow-up visits. Neurocognitive performance improved with years of ART. After adjusting for the expected effects of age using norms from HIV-negative individuals, the odds of neurocognitive impairment at follow-up visits among the HIV-infected increased by nearly 20% for each decade of advancing age.
Despite continued virologic suppression and neurocognitive improvement in the cohort as a whole, older individuals were more likely to have neurocognitive impairment than younger individuals.