Title

The effects of highly active antiretroviral therapy (HAART) on neuropsychological status in HIV-infection: A prospective study.

Date of Award

2006

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

Keywords

Psychology, Clinical.

Rights

CC BY-NC-ND 4.0

Abstract

The advent of highly active antiretroviral therapy (HAART) has resulted in significant reductions in HIV morbidity and mortality but the longitudinal effects on cognition are less well known. This longitudinal study examined the effects of highly active antiretroviral therapy (HAART) on cognitive performance in adults with HIV. Three hundred eighty-six adults representing all stages of HIV disease were tested at baseline and 180 of those subjects underwent a follow-up assessment. Subjects who were on HAART outperformed subjects on a non-HAART regimen, and those taking no antiretroviral medications, on the Grooved Pegboard Test, and were less impaired overall, at Time 1 and Time 2. Trends in the expected direction were found on other tests of psychomotor speed as well as on tests of attention and learning efficiency, however the group mean methodology failed to identify the breadth and depth of individual cognitive impairment across this sample. Longitudinal analyses using Reliable Change Indices indicated that 65% of the HIV-positive subjects had a stable cognitive profile during the follow-up time frame while 10% exhibited improved cognitive functioning and 26% deteriorated. Although there was a definite relationship between HAART and immune reconstitution, as well as HAART and viral suppression, a clear association between HAART and cognitive improvement was not identified. When the sample was restricted to individuals with CD4 cell counts < 200 mul, HAART was associated with cognitive change on selected measures of attention, psychomotor speed, learning efficiency and abstraction. Cognitive improvement was predicted by a model consisting of immune system response, initial cognitive impairment level, and estimated IQ. These findings suggest that the long-term effect of HAART on cognition is mediated by multiple factors. The dissociation between systemic and neurocognitive response to HAART that was identified in the current study supports a model of immune system-mediated cognitive disruption in HIV. As individuals with HIV survive longer, and potentially experience more cognitive impairment, more longitudinal research of this type is necessary to investigate the neurocognitive sequelae of HIV and response to HAART. Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 4106. Thesis (Ph.D.)--University of Windsor (Canada), 2006.