Background: Despite benefits on morbidity and mortality due to combined antiretroviral therapy (cART), HAND remains common in HIV individuals, with a variable prevalence in different cohorts. Aim of our study was to evaluate prevalence and predictive factors of HAND in more recent years.
Methods: Single-centre, retrospective, cross-sectional analysis of neurocognitive profile in HIV-infected ART-treated patients. All underwent neuropsychological assessment (NPA) by standardized battery of 14 tests on 5 different domains. Persons were classified as having HAND according to Frascati''s criteria. Chi-square for trend and multivariable logistic regression were fitted.
Results: A total of 1,289 NPA over 771 HIV-infected individuals were collected from 2009 to 2016. Main characteristics: male 80.2%; MSMs 48.6%; HCVAb+ 18.6%; HIV-RNA < 40 cp/mL at NPA 84.9%; median of 8.6years (3.9-17.6) of infection and 13years (8-15) of education; median of 233 cell/mm3 CD4+ nadir and 587 (419-772) cell/mm3 current CD4+. At NPA, 50.7% of pts were receiving NRTI+NNRTI, 28.3% NRTI+PI/r and 3.8% NRTI+INSTI. In 461/1,289 (35.8%) tests a cognitive complaint in deficit of memory, attention or concentration was reported. HAND prevalence was 45.5% in complaining (ANI=24%; MND=18%; HAD=3%) and 14% in non-complaining patients (ANI=11%; MND=3%; HAD=0). Prevalence over time of HAND was stable in complaining (p at chi square for trend=0.134), but decreased in 2013-2016 in non-complaining (p < 0.001). Factors associated to HAND by multivariable logistic regression were older age, lower educational level, lower CD4+ count and detectable HIV-RNA at NPA (Table). Patients tested in more recent years show a reduced risk of HAND.
Conclusions: A decreasing prevalence of HAND was observed in more recent years among patients without a cognitive complaint. Better viroimmunological state was correlated to a lower risk of HAND, while worse educational level and older age to a higher one. Besides HIV-related factors, patient characteristics, more than treatment-associated variables, affect risk of neurocognitive impairment.