Declining prevalence of HIV-associated neurocognitive disorders in more recent years and associated factors, in a large cohort of ART-treated HIV-infected individuals
التفاصيل البيبلوغرافية
العنوان:
Declining prevalence of HIV-associated neurocognitive disorders in more recent years and associated factors, in a large cohort of ART-treated HIV-infected individuals
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.
سنة النشر:
2022
الوصف:
Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) have been suggested as persistent even with effective antiretroviral therapy (ART). Aims were to evaluate HAND prevalence and associated factors, in a large cohort of people-living-with-HIV (PLWH).ART-treated PLWH, underwent a neuropsychological examination through a battery of 12 tests exploring 5 different domains, between 2009-2020, were included in this cross-sectional analysis. HAND were classified according to Frascati's criteria. Participants were defined as complaining or not-complaining if a cognitive complaint was reported or not. Chi-square for trend and multivariable logistic regression were fitted.Overall, 1,424 PLWH were enrolled during four three-years periods. HAND prevalence was 24%. Among complainers (572/1,424), HAND prevalence was 38%, higher than among not-complainers (15%). Over the study period, a decreasing HAND prevalence was found in the entire population (p 0.001) and in complaining (p 0.001); in not-complaining it remained stable (p = 0.182). Factors associated with HAND were older age, lower educational level, lower current CD4+ T-cell count and HCV co-infection. Compared to Non-Nucleoside Reverse Transcriptase Inhibitors, individuals receiving dual and Integrase Strand Transfer Inhibitor (INSTI)-based therapies were associated with a decreased risk of HAND, as well as participants tested in more recent years.In this large cohort of ART-treated PLWH, mostly virologically suppressed, a remarkable decreasing HAND prevalence was observed. Besides HIV- and patient-related factors, the reduced risk of HAND found with dual and INSTI-based regimens along with a more recent ART initiation, could suggest a potential role of new treatment strategies in this decline, due to their greater virologic efficacy and better tolerability.
