ART Reduces Neurocognitive Impairment in Patients Living With HIV

graphic depiction of brain activity
graphic depiction of brain activity
Initiating ART may reduce the risk for neurocognitive impairment in patients living with HIV.

Initiating antiretroviral therapy (ART) may reduce the risk for neurocognitive impairment in patients living with HIV, according to study results published in Clinical Infectious Diseases.

The study included participants from the AIDS Clinical Trials Group (ACTG) 5199 (International Neurological Study [INS]). Participants were from 7 resource-limited countries and HIV-positive. Participants in the study were ART-naïve with CD4+ cell counts <300 and were randomly assigned to start 1 of 3 World Health Organization-recommend first-line ART regimens.

The researchers applied normative data from the International Neurocognitive Normative Study (INNS) to INS. INNS included normative comparison data on high-risk HIV-negative participants from 10 voluntary counseling and testing sites. The researchers used generalized estimating equations to estimate associations.

Of the 860 HIV+ participants from ACTG 5199, 55% had no neurocognitive impairment at baseline, 25% had mild neurocognitive impairment, 17% had moderate impairment, and 3% had severe impairment.

After ART initiation, the rate of neurocognitive impairment dropped substantially, with 37% of participants impaired at week 24, 36% at week 48, 31% at week 72, 27% at week 96, 26% at week 120, 29% at week 144, 26% at week 168, and 20% at week 192.

ART also decreased the rates of moderate and severe impairment, with the number of participants with moderate impairment decreased to 6% and participants with severe impairment decreased to 0.6% at week 168.

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The researchers calculated that the initiation of ART reduced the estimated odds of neurocognitive impairment by 12% for every 24 weeks on ART (P <.0001).

“These improvements in neurocognitive performance would likely lead to sustained improvements in productivity and quality of life in those living with HIV in [resource limited settings],” the researchers wrote.


Robertson KR, Jiang H, Kumwenda J, et al. HIV associated neurocognitive impairment in diverse resource limited settings [published online September 13, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy767