Date of Award

January 2015

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Serena Spudich

Subject Area(s)

Medicine

Abstract

Acute HIV infection (AHI) is accompanied by central nervous system infection and immune activation. We investigated baseline predictors of neuropsychological (NP) performance in Thai participants with AHI and the effect of antiretroviral therapy (ART) on domains of functioning known to be affected by HIV.

36 participants with AHI (89% male, median age of 28 years, median time since HIV exposure of 19 days) were evaluated at baseline and 3 and 6 months after ART. Performance on the Grooved Pegboard test (GP), Color Trails 1 & 2 (CT1, CT2), and Trails Making Test A (TM) were standardized to 251 age and education matched HIV-uninfected Thais and summarized as a composite score (NPZ-4). Change in NP performance from baseline to 6 months was compared between AHI participants and matched Thai HIV- controls (n=45, 51% male, median age of 36 years) to account for practice effects. Analyses included Spearman correlation, multivariable regression, non-parametric repeated measures ANOVA, and Mann-Whitney U test.

Baseline NP scores for the AHI group were similar to controls on each test (z scores range: -0.26 to -0.13). NP performance was negatively correlated with cerebrospinal fluid (CSF) HIV RNA (r = -0.493, p = 0.023) and days post-transmission (r = -0.389, p = 0.019). NP performance improved on CT1, CT2, and TM in the initial 3 months (ps <0.01) with no significant change during the last 3 months. Only improvement in CT1 was greater than that seen in controls at 6 months (p=0.018). Eight participants performed >1 standard deviation below normative means on >2 NP tests at baseline. This subgroup had higher cerebrospinal fluid (CSF) HIV RNA compared to the rest of the AHI group (p=0.047) and exhibited no improvement in NP performance across the follow-up periods.

Most AHI individuals had normal NP performance and early ART slightly improved their psychomotor function. However, approximately 25% of AHI individuals had impaired NP performance which correlated with higher CSF HIV RNA, and these abnormalities were not reversed by early short-term ART possibly indicating limited reversibility of cognitive impairment in a subset of AHI individuals.

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