Bottom Line: Adults with human immunodeficiency virus (HIV) and good viral suppression on combination antiretroviral therapy had poorer cognition and reduced brain thickness and volume on magnetic resonance imaging than adults without HIV, but changes over time in cognitive performance and brain structure were similar between the two groups over two years.
Why The Research Is Interesting: Treatment with combination antiretroviral therapy (cART) has helped make HIV a chronic condition but many patients experience neurocognitive deficits associated with HIV that affect their quality of life. It is important to know if effective cART therapy prevents brain atrophy and cognitive decline that has been observed in untreated HIV patients or in those treated but with poor viral suppression.
Who: 48 adults with HIV treated with cART with good viral suppression; 31 adults for comparison who did not have HIV; both groups were about half women, had average ages of nearly 48 (HIV-positive adults) and 51 (HIV-negative adults), and an average of 13 to 14 years of education.
What (Study Measures): Brain changes (cortical thickness and subcortical volumes) on magnetic resonance imaging (MRI) and cognitive performance using neuropsychological assessments during a two-year period.
How (Study Design): This is an observational study. In observational studies, researchers observe exposures and outcomes for patients as they occur naturally in clinical care or real life. Because researchers are not intervening for purposes of the study they cannot control natural differences that could explain study findings so they cannot prove a cause-and-effect relationship.
Authors: Ryan Sanford, M. Eng., of McGill University, Montreal, Canada, and coauthors
Results: Adults with HIV had poorer cognitive performance and smaller cortical thickness and subcortical volumes in their brains compared with adults without HIV, but there were no significant losses in brain volume or cognitive decline over a two-year period.
Study Limitations: Data on vascular risk factors were not collected so vascular injury cannot be excluded as contributing factor to smaller brain volumes and cognitive deficits; adults with HIV who were included had few comorbidities; using other tests to measure cognition could have yielded additional results.
Study Conclusions: Changes in brain structure and cognition in HIV patients may be due to brain injury from HIV that happens earlier when the infection is untreated, and effective cART therapy with viral suppression appears to halt progression of the change.
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(doi:10.1001/jamafacial.2017.3036)
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Journal
JAMA Neurology