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From Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA (M.A.C., E.N.M.); Molecular Microbiology and Immunology (J.B.M.), Epidemiology (C.C., X.L.), Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD; Neurology, School of Medicine, The Johns Hopkins University, Baltimore, MD (O.A.S., N.S.); Psychiatry, University of Illinois at Chicago, Chicago, IL (E.M.M.); Neurology and Psychiatry, University of Pittsburgh, Pittsburgh, PA (J.T.B.); Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA; School of Public Health, University of California, Los Angeles, CA (H.A.A.); and Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL (B.C.).
Address correspondence and reprint requests to Dr. Michael A. Cole, University of Hawaii, Queen’s University Tower, 7th Floor, 1356 Lusitana St., Honolulu, HI 96813 colema{at}hawaii.edu
Background: Recent case reports have suggested that some asymptomatic HIV-infected individuals can develop CNS disturbances despite intact immunologic functioning and long-term suppression of plasma HIV concentrations to undetectable levels. This possibility has not yet been systematically studied longitudinally.
Methods: Using longitudinal data from the Multicenter AIDS Cohort Study, we investigated neuropsychological performance in long-term asymptomatic HIV-infected men who have sex with men. Performance over a 5-year period on the Symbol Digit Modalities test and the Trail Making Tests were compared in three HIV-positive asymptomatic groups [defined as 1) highly active antiretroviral therapy (HAART) treated with undetectable viral loads (n = 83), 2) AIDS-free for more than 15 years without HAART (n = 29), and 3) absence of clinical AIDS or CD4+ lymphocyte count below 200 cells/µL at the beginning and end of the study period (n = 233)] and in HIV-negative controls (n = 237). Data were analyzed using linear mixed models and proportional odds logistic regression modeling with generalized estimating equations.
Results: There was no evidence of performance differences or performance declines over the 5-year period of study in any of the three long-term asymptomatic groups as compared with the HIV-negative group in the Symbol Digit Modalities test or the Trail Making Tests. Performance decrements were, however, observed with increasing age in each of the tests administered, demonstrating that performance declines could be detected by these methods.
Conclusions: Regardless of how long-term asymptomatic status was defined immunologically or virologically, neuropsychological test performances remained stable. These findings suggest that psychomotor speed is preserved over many years in HIV-infected individuals with controlled HIV viremia.
Abbreviations: HAART = highly active antiretroviral therapy; HAART–UVL = HAART–undetectable viral loads; LTDNP = long-term disease nonprogressors; MACS = Multicenter AIDS Cohort Study; SDM = Symbol Digit Modalities test; WAIS-R = Wechsler Adult Intelligence Scale–Revised.
Supplemental data at www.neurology.org
Editorial, see page 2195
e-Pub ahead of print on October 3, 2007, at www.neurology.org.
*See appendix for complete list of Multicenter AIDS Cohort Study centers and investigators.
Disclosure: The authors report no conflicts of interest.
Received January 19, 2007. Accepted in final form May 25, 2007.
This article has been cited by other articles:
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  R. A. Cohen and B. A. Navia Preserved cognitive functioning over time in asymptomatic HIV-infected people in the MACS cohort Neurology, December 11, 2007; 69(24): 2195 - 2196. [Full Text] [PDF]
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