Summary

The CHARTER study is a large study conducted in the US that aims to determine how central and peripheral nervous system complications of HIV are affected by different histories and regimens of antiretroviral therapy (ART). This secondary analysis of the CHARTER data focuses on HIV-positive individuals with well-controlled virus levels. The researchers wanted to predict the risk of cognitive decline (thinking and memory problems) over three years in these individuals. They found that certain factors, like kidney function, duration of HIV infection, education level, and a specific protein in the cerebrospinal fluid, could help predict the risk of cognitive decline. They developed a risk index using these factors, which could be used by doctors to estimate an individual’s risk of cognitive decline and offer targeted interventions to reduce that risk. The study suggests that managing vascular risk factors could potentially help prevent cognitive decline in HIV-positive individuals. However, more research is needed to validate these findings and understand how to best protect against cognitive decline in this population.

Abstract

Background:

Little is known about the predictors of neurocognitive decline in HIV+ individuals with good virological control. Identification of modifiable risk factors would allow targeted interventions to reduce the risk of decline in higher risk individuals. The objective of this study was to develop a risk index to predict neurocognitive decline over 3 years in aviremic HIV+ individuals.

Methods:

As part of the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study, HIV+ adults completed clinical evaluation and neuropsychological tests every 6 months. Group-based trajectory analysis was used to detect patterns of neurocognitive change; individuals who deteriorated ≥ 0.5 SD on at least one neuropsychological test were considered decliners. Multiple logistic regression was used to identify baseline sociodemographic, clinical, biological, and lifestyle factors associated with decline in the subgroup that was consistently aviremic during the first 3 years. A risk index was developed using the beta-coefficients from the final regression model.

Results:

Neurocognitive decline occurred in 23 of 191 (12%) participants followed longitudinally. The baseline factors that predicted decline were glomerular filtration rate ≤50 mL/min, known duration of HIV infection ≥15 years, education ≤12 years, and cerebrospinal fluid protein >45 mg/dL.

Conclusions:

Using this analytic approach, neurocognitive decline was uncommon in this sample of aviremic HIV+ individuals. The 3-year risk of decline ranged from 2% in those with no risk factors to 95% in those with all 4. The strongest predictor was glomerular filtration rate, also a predictor of cardiovascular disease. This raises the possibility that controlling vascular risk factors could reduce the risk of neurocognitive decline.

DOI: https://doi.org/10.1097/qai.0000000000001466

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