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| |  Neurological Impairment Observed Early in HIV-Infection: Presented at CROI By Ed Susman SAN FRANCISCO -- February 21, 2010 -- Patients with HIV often appear to experience subtle neurological impairments -- even in the very early stages of infection, researchers said here at the 17th Conference on Retroviruses and Opportunistic Infections (CROI). In 1 study, among 37 patients evaluated a median of 3.5 months after initial HIV infection, 24 patients “had evidence of impairment on 1 or more composite neuropsychological test Z scores, registering greater than 1 standard deviation below the mean,” said Julia Peterson, University of California, San Francisco (UCSF), San Francisco, California, Dr. Peterson said 16 of the patients had 1 test indicating impaired functioning, 6 had impairment observed in 2 tests, and 2 patients were impaired on 3 tests. “Whether this impairment reflects premorbid factors or an effect of HIV in the nervous system requires further study with well-matched, uninfected control subjects,” said Dr. Peterson on February 18. In another study, David Moore, MD, UCSF, and colleagues reviewed neurological outcomes among 39 patients diagnosed with acute early HIV infections (within 1 year of infection) and 63 patients with chronic HIV infection. They found that 21% of the patients with early HIV infection showed signs of neuropsychological deficits. Patients with chronic HIV infection showed a higher level of neuropsychological deficits that examined global neuropsychological functioning, verbal fluency, executive functioning, and other areas. “Our preliminary findings suggest that neuropsychological complications can occur in acute and early HIV-infection,” said Dr. Moore during a poster presentation adjacent to the other study. Dr. Moore’s study was part of the larger trial -- The CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study -- which determined that 45% of all HIV-positive patients had at least mild neuropsychological impairments. The impairments Dr. Moore measured were also mild in nature. “It is unclear why neuropsychological impairments persist in the antiretroviral treatment era,” he said. He suggested that events during the acute and early HIV-infection stages “may set the stage for neurological disease during chronic infection.” “These 2 studies are remarkable in that we both observed the same phenomenon in this group of early HIV-infected patients,” said lead investigator Serena Spudich, MD, of UCSF. The studies were funded through United States government agencies or from internal institutional sources. [Presentation titles: Neurocognitive Performance During Primary HIV-1 Infection. Abstract 424.andHIV-Associated Neurocognitive Disorder in Acute and Early HIV Infectio. Abstract 423]
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