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| |  Lower CD4 Cell Counts Linked to Increased Risk of Cognitive Impairment: Presented at AIDS 2010 By Ed Susman VIENNA -- July 27, 2010 -- A patient with HIV infection has an increased likelihood of experiencing neurocognitive impairment as CD4-cell counts decrease -- even if they recover with treatment, researchers stated here at the 18th International AIDS Conference. In an analysis of more than 1,500 patients infected with HIV, researchers found that having a CD4+ cell count of more than 350 cells/mL was associated with a nearly 40% reduction in the risk of experiencing cognitive impairment, said Igor Grant, MD, University of California, San Diego School of Medicine, San Diego, California. "The relationship between CD4 nadir and neurocognitive impairment remained significant after adjusting for multiple demographic and clinical characteristics," Dr. Grant explained at his late-breaker oral presentation here on July 22, 2010. Dr. Grant illustrated a "dose-dependent" relationship: About a 28% reduction in risk of neurocognitive impairment is associated with a CD4+ cell nadir of 200-349 cells/mL. About a 15% reduction in risk of neurocognitive impairment is associated with a CD4+ cell nadir of 50-199 cells/mL. Those figures are compared with a reference level of a CD4+ cell count of <50 cell/mL. "In a subset of participants on antiretroviral therapy with undetectable plasma viral load, a low CD4 nadir remained a significant predictor of neurocognitive impairment after adjustment for ethnicity and comorbidity status," Dr. Grant said. "CD4 nadir may represent a 'legacy event' that contributes substantially to HIV-related brain injury and neurocognitive impairment," Dr. Grant added. "Prevention of severe immunosuppression by earlier antiretroviral therapy initiation may lead to more favourable neurocognitive outcomes in HIV-positive individuals." Researchers enrolled 1,525 patients in this study, including 799 individuals diagnosed with neurocognitive impairment and 726 participants with unimpaired neurocognitive functioning. Participants were about 42-years-old, and more than 75% were men. Approximately 40% were white. The time from the recalled CD4 nadir was about 2.3 years. "Prevention of severe immunosuppression may lead to more favourable neurocognitive outcomes," Dr. Grant said. "A controlled clinical trial of early versus delayed antiretroviral initiation is needed to assess whether early intervention is safe and efficacious for preventing HIV-associated neurocognitive decline." [Presentation title: Nadir CD4 Is a Predictor of HIV Neurocognitive Impairment in the Era of Combination Antiretroviral Therapy: Results from the CHARTER Study. Abstract THLBB109]
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