Neuropsychological Impairment Detected Early in Course of HIV

"We know that the virus [HIV] gets across the brain pretty quickly,

and then we think that there are these central nervous system

reservoirs, so it’s hiding out in the brain," session comoderator Dr.

Beau Ances noted in an interview. "The question is, in these individuals

with primary HIV infection, is there any kind of signature that we can

see even early on that indicates the brain is being affected? And if so,

would that affect our treatment strategy for these individuals, because

primarily, our way of diagnosing and also following an individual is

using the plasma viral load or their CD4 count."

Not

only did a sizable proportion of patients already have

neuropsychological impairments at baseline, but motor performance

continued to decline before ART initiation, he noted. Thus, the findings

may speak to a need to intervene earlier in the course of disease.

"What

was interesting was, one, these deficits are present and they are

present early in the disease. And, two, some domains seem to be

preferentially affected compared to others," Dr. Ances said.

"From

my point of view, this is very interesting in that it does bring up

some considerations as to when to start [ART] or a neuroprotective

medication," he commented. "This would suggest that maybe we need to

consider ART in these individuals and start them much earlier, since

there is damage that seems to be going on. And then targeted cognitive

rehabilitation in certain domains may be very important."

Dr. Ances is assistant professor of neurology at the Washington University School of Medicine in St. Louis. He disclosed being on the advisory committee for Lilly and working on an antidementia drug trial for Pfizer.