Yuen T, et al. – This study was planned to develop a risk index to predict neurocognitive decline over 3 years in aviremic HIV+ individuals. The analytic approach indicated an uncommon occurrence of neurocognitive decline in aviremic HIV+ individuals. The 3–year risk of decline ranged from 2% in those with no risk factors to 95% in those with all 4. Glomerular filtration rate was identified as the strongest predictor. This raises the possibility that controlling vascular risk factors could reduce the risk of neurocognitive decline.

Methods

• HIV+ adults completed clinical evaluation and neuropsychological tests every 6 months as part of the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study.
• To detect patterns of neurocognitive change, researchers used group-based trajectory analysis; decliners were the individuals who deteriorated ≥ 0.5 SD on at least one neuropsychological test.
• They used multiple logistic regression to identify baseline sociodemographic, clinical, biological, and lifestyle factors associated with decline in the subgroup that was consistently aviremic during the first 3 years.
• They developed a risk index using the beta-coefficients from the final regression model.

Results

• 23 of 191 (12%) participants followed longitudinally indicated neurocognitive decline.
• As per observations, glomerular filtration rate ≤50 mL/min, known duration of HIV infection ≥15 years, education ≤12 years, and cerebrospinal fluid protein >45 mg/dL at baseline predicted decline.