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Antiretroviral therapy improves cognitive impairment in HIV+ individuals in sub-Saharan Africa

From the Departments of Neurology (N.S.) and Orthopedics (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Departments of Psychiatry (N.N.) and Medicine (S.M., E.K.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina, Chapel Hill; Department of Neurology (M.W.), University of Virginia, Charlottesville; and Department of Internal Medicine (A.R.), University of Manitoba, Winnipeg, Canada.

Address correspondence and reprint requests to Dr. N. Sacktor, Department of Neurology, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., B Bldg., Rm. 123, Baltimore, MD 21224; e-mail: sacktor{at}jhmi.edu

Background: Highly active antiretroviral therapy (HAART) can improve cognitive performance in some patients with HIV-associated cognitive impairment in the United States. The effect of HAART on HIV dementia in sub-Saharan Africa is largely unknown.

Objective: To evaluate neuropsychological test and functional performance in HIV+ individuals after 3 and 6 months of HAART in Uganda.

Methods: Twenty-three HIV+ individuals receiving HAART also received a detailed clinical history, neuropsychological testing, and a functional assessment. Follow-up evaluations were performed at 3 and 6 months after baseline. Longitudinal changes in the HIV dementia stage, the mean Z score for each neuropsychological test, and the Karnofsky Functional Performance Scale were evaluated at 3 and 6 months.

Results: The mean (SD) CD4 cell count improved from 71 (15) at baseline to 161 (30) at 3 months (p = 0.005) and 222 (46) at 6 months (p < 0.001). Improvements were found in the Memorial Sloan Kettering HIV dementia stage and in tests of verbal memory, psychomotor speed, and executive functioning after 3 and 6 months of HAART (p < 0.001 at 6 months for each neuropsychological test). There was also improvement in the Karnofsky Functional Performance Scale at both 3 and 6 months after the initiation of HAART (p < 0.001).

Conclusion: Highly active antiretroviral therapy (HAART) can be associated with improvement in neurocognitive and functional performance in HIV+ individuals in sub-Saharan Africa. These results suggest that HAART, if available in areas with limited resources in sub-Saharan Africa, should be provided for patients with HIV-associated cognitive impairment.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 25 issue to find the title link for this article.

Supported by the Bill and Melinda Gates Foundation and the Academic Alliance Foundation (which has received support from Pfizer Pharmaceuticals).

Disclosure: The authors report no conflicts of interest.

Received October 11, 2005. Accepted in final form March 21, 2006.

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