Cognitive functioning during highly active antiretroviral therapy interruption in human immunodeficiency virus type 1 infection
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- 作者：Meredith E. Childers (1) (2)
Steven Paul Woods (2) (3)
Scott Letendre (2) (4)
J. Allen McCutchan (2) (4)
Debralee Rosario (2) (3)
Igor Grant (2) (3)
Monica Rivera Mindt (5)
Ronald J. Ellis (1) (2) - 关键词：HIV ; viral load ; treatment interruption ; HAART ; neuropsychological assessment
- 刊名：Journal of NeuroVirology
- 出版年：2008
- 出版时间：November 2008
- 年：2008
- 卷：14
- 期：6
- 页码：550-557
- 全文大小：172KB
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Steven Paul Woods (2) (3)
Scott Letendre (2) (4)
J. Allen McCutchan (2) (4)
Debralee Rosario (2) (3)
Igor Grant (2) (3)
Monica Rivera Mindt (5)
Ronald J. Ellis (1) (2)
1. Department of Neurosciences, University of California at San Diego, San Diego, California, USA
2. HIV Neurobehavioral Research Center, University of California, San Diego, 150 West Washington Street, 2nd Floor, 92103, San Diego, CA, USA
3. Department of Psychiatry, University of California at San Diego, San Diego, California, USA
4. Department of Medicine, University of California at San Diego, San Diego, California, USA
5. Fordham University, New York, New York, USA - ISSN：1538-2443
文摘
Although no longer considered therapeutically beneficial, antiretroviral treatment interruptions (TIs) still occur frequently among patients with human immunodeficiency virus (HIV) infection for a variety of reasons. TIs typically result in viral rebound and worsening immunosuppression, which in turn are risk factors for neurocognitive decline and dementia. We sought to determine the extent of neurocognitive risk with TIs and subsequent reintroduction of highly active antiretroviral therapy (HAART) by using a comprehensive, sensitive neuropsychological assessment and by concurrently determining changes in plasma and cerebrospinal fluid (CSF) viral load and CD4 counts. Prospective, serial, clinical evaluations including neuropsychological (NP) testing and measurement of plasma HIV RNA and CD4 count and mood state were performed on HIV-1—infected individuals (N=11) at three time points: (1) prior to a TI, while on HAART; (2) after TIs averaging 6 months; and (3) after reinitiating HAART therapy. During TI, plasma HIV RNA increased and CD4 counts declined significantly, but NP performance did not change. Following reinitiation of HAART, viral loads fell below pre-TI levels, and CD4 counts rose. Improved viral suppression and immune restoration with reinitiation of HAART resulted in significant improvement in neurocognitive performance. No changes on comprehensive questionnaires of mood state were observed in relation to TI. NP performance and mood state remained stable during TIs despite worsened viral loads and CD4 counts. Because “practice effects-are generally greatest between the first and second NP testing sessions, improvement at the third, post-TI time point was unlikely to be accounted for by practice. TIs of up to 6 months appear to be neurocognitively and psychiatrically safe for most patients.