Frequency of HIV-associated neurological disorders over four years of follow-up: results from the Multicenter AIDS Cohort Study (P2.315)

Background: Prior to the introduction of combination antiretroviral therapy (cART) in 1996, HIV associated neurocognitive disorders (HAND) was a progressive condition leading to death within months. The question arises whether HAND continues to be a progressive neurocognitive condition in HIV+ individuals receiving cART.Objective: To evaluate the frequency of HAND in HIV+ individuals, and to determine whether the frequency of HAND changes over four years of follow-up.Methods: The Multicenter AIDS Cohort Study (MACS) is a prospective study of gay/bisexual men. In 2007, HIV+ individuals without confounding conditions received a full neuropsychological test battery every two years and functional assessments to allow for a classification HAND. 197 HIV+ individuals were seen at all three visits from 2007-2012.Results: The overall frequency of HAND for HIV+ individuals during the 2007-2008, 2009-2010, and 2011-2012 periods were 25[percnt], 25[percnt], and 31[percnt] respectively. The overall frequency of HAND increased over this four year period (p=0.048) due to an increase in the frequency of asymptomatic neurocognitive impairment from 12[percnt] in 2007-2008, and 8[percnt] in 2009-2010, to 19[percnt] in 2011-2012 (p=0.014). Frequencies of mild neurocognitive disorder (11[percnt], 15[percnt], and 10[percnt] in the three time periods) and dementia (2[percnt], 3[percnt], and 2[percnt] in the three time periods) were unchanged. From the 2007-2008 time period to the 2011-2012 time period, 77[percnt] of the HIV+ individuals remained at their same HAND stage, with 13[percnt] showing deterioration in HAND stage and 10[percnt] showing an improvement in HAND stage.Conclusion: HAND is still common in HIV+ individuals in the cART era. However, for the majority of HIV+ individuals on cART with systemic virological suppression, the diagnosis of HAND is not a progressive clinical condition over four years of follow-up. Future studies should evaluate longitudinal changes in HAND over a longer period of time.Study Supported by: AI035042 Disclosure: Dr. Sacktor has nothing to disclose. Dr. Reynolds has nothing to disclose. Dr. Skolasky has nothing to disclose. Dr. Munro has nothing to disclose. Dr. Becker has nothing to disclose. Dr. Martin has nothing to disclose. Dr. Ragin has nothing to disclose. Dr. Levine has nothing to disclose. Dr. Miller has nothing to disclose.