Neurocognitive impairment in HIV infected individuals with advanced immunosuppression and its relationship with antiretroviral therapy

Abstract

With the introduction of Highly Active Antiretroviral Therapy (HAART), AIDS has newlinebecome a chronic manageable disease resulting in increased longevity of HIV infected newlineliving with HIV is likely to result in newlineincreasing reports of metabolic complications, non opportunistic conditions, newlinemalignancies and HIV associated neurocognitive disorders. Indian studies have reported newlinelow prevalence of dementia and high prevalence of neurocognitive impairment in newlineantiretroviral naïve patients. However, there is no data from a systematically conducted newlineprospective study that has made use of a comprehensive test battery to detect newlineneurocognitive impairment. Also the effects of antiretroviral therapy on neurocognitive newlinedisorders in AIDS patients have not been studied in India. The current thesis reports newlineprevalence of neurocognitive disorders among AIDS patients and status of newlineneurocognitive impairment at baseline and one year after initiation of antiretroviral newlinedrugs. The association between selected plasma biomarker levels (cytokines and newlinechemokines) estimated at baseline and neurocognitive impairment as well as changes in newlinetheir levels one year after antiretroviral therapy initiation was also studied. newlineHowever, at an individual level, showed an overall improvement in global scores and newlinealso in the domains of learning, executive functioning and motor performance from newlinebaseline to one year after ART initiation were observed indicating possible beneficial newlineeffect of the anti-retroviral treatment on neurocognition at an individual level in the HIV newlineinfected individuals. The Beck depression scores in HIV infected participants improved newlineafter one year of ART initiation. The summary of findings on levels of plasma newlinebiomarkers in HIV infected participants showed that there was no significant difference newlinebetween the levels of biomarkers (cytokines and chemokines) in both the groups at newlinebaseline and at yearly follow up visits. However, CART analysis (Classification and Regression Tree) at baseline showed that higher IP-10 and lower MIP-1 alpha, RANTES newlineand IL 10