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From the Department of Neurology (Drs. Sacktor, Selnes, and McArthur, and R.L. Skolasky), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (Dr. Lyles and G. McFarlane), The Johns Hopkins School of Hygiene and Public Health, Baltimore, MD; Neuropsychiatric Institute (Drs. Anderson and Miller), University of California, Los Angeles, CA; Neuropsychology Research Program (Dr. Becker), University of Pittsburgh Medical Center, Pittsburgh, PA; and Departments of Neurology (Dr. Cohen) and Neuropsychology (Dr. Wesch), Northwestern University Medical School, Chicago, IL.
Address correspondence and reprint requests to Dr. Ned Sacktor, Johns Hopkins Bayview Medical Center, Department of Neurology, 4940 Eastern Ave., Baltimore, MD 21224.
BACKGROUND: Combination antiretroviral therapy including protease inhibitors (combo+PI) is effective in suppressing systemic viral load in HIV infection, but its impact on HIV-associated cognitive impairment is unclear.
OBJECTIVE: To determine whether psychomotor speed, a sensitive measure of impairment in HIV dementia, improves with combo+PI compared with other antiretroviral treatments.
METHODS: A total of 411 HIV-seropositive (HIV+) homosexual men (with longitudinal neuropsychological testing) in the Multicenter AIDS Cohort Study and, in a separate analysis, 282 HIV+ homosexual men with psychomotor slowing at baseline were classified by treatment into four groups: antiretroviral naïve (no antiretroviral medication treatment), monotherapy, combination antiretroviral therapy without protease inhibitors (combo-noPI), and combo+PI. We compared longitudinal performance on three tests of psychomotor speed: the Grooved Pegboard (GP) (nondominant and dominant hands), Trail Making Test B, and the Symbol Digit Modalities Test (SDMT).
RESULTS: Relative to antiretroviral-naïve and monotherapy participants, on the GP nondominant hand test, combo+PI participants with abnormal baseline neuropsychological testing showed improved performance (difference = +0.63 standard deviation [SD], p = 0.02). For the SDMT, both combo+PI participants (difference = +0.26 SD, p = 0.03) and combo-noPI participants (difference = +0.29 SD, p = 0.01) with abnormal baseline neuropsychological testing improved compared with antiretroviral-naïve and monotherapy groups.
CONCLUSION: Combo+PI and combo-noPI are associated with improved psychomotor speed performance in HIV+ homosexual men with abnormal neuropsychological testing.
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