No neurocognitive advantage for immediate antiretroviral treatment in adults with greater than 500 CD4+ T-cell counts
AIDS
; 32(8): 985-997, May 2018. tab, ilus
Article
in English
| Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP
| ID: biblio-1022672
Responsible library:
BR31.1
Localization: BR31.1; 2018_P-007
ABSTRACT
OBJECTIVE:
To compare the effect of immediate versus deferred antiretroviral treatment (ART) on neuropsychological test performance in treatment-naive HIV-positive adults with more than 500 CD4 cells/µl.DESIGN:
Randomized trial.METHODS:
The START parent study randomized participants to commence immediate versus deferred ART until CD4 less than 350âcells/µl. The START Neurology substudy used eight neuropsychological tests, at baseline, months 4, 8, 12 and annually, to compare groups for changes in test performance. Test results were internally standardized to z-scores. The primary outcome was the average of the eight test z-scores (QNPZ-8). Mean changes in QNPZ-8 from baseline were compared by intent-to-treat using longitudinal mixed models. Changes from baseline to specific time points were compared using ANCOVA models.RESULTS:
The 592 participants had a median age of 34 years; median baseline CD4 count was 629âcells/µl; the mean follow-up was 3.4 years. ART was used for 94 and 32% of accrued person-years in the immediate and deferred groups, respectively. There was no difference between the immediate and deferred ART groups in QNPZ-8 change through follow-up [-0.018 (95% CI -0.062 to 0.027, Pâ=â0.44)], or at any visit. However, QNPZ-8 scores increased in both arms during the first year, by 0.22 and 0.24, respectively (Pâ<â0.001 for increase from baseline).CONCLUSION:
We observed substantial improvement in neurocognitive test performance during the first year in both study arms, underlining the importance of using a control group in studies assessing neurocognitive performance over time. Immediate ART neither benefitted nor harmed neurocognitive performance in individuals with CD4 cell counts above 500âcells/µl
Full text:
Available
Collection:
National databases
/
Brazil
Health context:
SDG3 - Health and Well-Being
Health problem:
Target 3.3: End transmission of communicable diseases
Database:
Sec. Est. Saúde SP
/
SESSP-IIERPROD
Main subject:
HIV Infections
/
Neurocognitive Disorders
/
Antiretroviral Therapy, Highly Active
Type of study:
Controlled clinical trial
/
Prognostic study
Limits:
Adult
/
Humans
Language:
English
Journal:
AIDS
Year:
2018
Document type:
Article
Institution/Affiliation country:
Burnet Institute/AU
/
Chulalongkorn University/TH
/
Imperial College London/GB
/
Institute for Clinical Research/US
/
Institute of Tropical Medicine/BE
/
Monash University/AU
/
People in Need Agency (PINA)/UG
/
Secretaria de Estado da Saúde. São Paulo/BR
/
St. Vincent's Hospital Sydney/AU
/
University College London/GB