A decreasing CD4/CD8 ratio over time and lower CSF-penetrating antiretroviral regimens are associated with a higher risk of neurocognitive deterioration, ... View Full Text


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Article Info

DATE

2016-11-04

AUTHORS

Matteo Vassallo, R. Fabre, J. Durant, C. Lebrun-Frenay, H. Joly, M. Ticchioni, F. DeSalvador, A. Harvey-Langton, B. Dunais, M. Laffon, J. Cottalorda, P. Dellamonica, C. Pradier

ABSTRACT

Persistent immune activation is one of the suspected causes of HIV-associated neurocognitive disorders (HAND) in cART era. The CD4/CD8 ratio has been recently showed as a marker of immune activation and HAND. Our aim was to analyze if a decrease in the CD4/CD8 ratio over time could have an impact on neurocognitive deterioration. Randomly selected HIV-infected patients were followed for neuropsychological (NP) testing during a period of almost 2 years. Tests were adjusted for age, gender, and education. Patients were divided into 5 groups: normal tests (NT), neuropsychological deficit (ND, one impaired cognitive domain), asymptomatic neurocognitive disorders (ANI), mild neurocognitive disorders (MND), and HIV-associated dementia (HAD). Risk factors for neurocognitive deterioration were analyzed. Two hundred fifty-six patients underwent NP tests and 94 participated in the follow-up. The groups were comparable. Upon neuropsychological re-testing, six patients showed clinical improvement, 30 had worsened, and 58 were stable, resulting in 42 patients presenting with HAND (45 %). The majority of HAND cases consisted of ANI (26 %) and MND (16 %). In patients whose NP performance worsened, CPE 2010 score was lower at inclusion (7.13 vs 8.00, p = 0.003) and CD4/CD8 decrease more frequent (60 vs 31 %, p = 0.008) than in those who were stable or improved. Multivariate analysis confirmed these results. A decreasing CD4/CD8 ratio during a longitudinal follow-up of randomly selected HIV-infected patients and lower CSF-penetrating regimens were independently associated with cognitive decline. Monitoring trends in CD4/CD8 ratio could contribute to identifying patients at higher risk of neurocognitive deterioration. More... »

PAGES

216-225

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s13365-016-0490-z

DOI

http://dx.doi.org/10.1007/s13365-016-0490-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1030708300

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27815816


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32 schema:description Persistent immune activation is one of the suspected causes of HIV-associated neurocognitive disorders (HAND) in cART era. The CD4/CD8 ratio has been recently showed as a marker of immune activation and HAND. Our aim was to analyze if a decrease in the CD4/CD8 ratio over time could have an impact on neurocognitive deterioration. Randomly selected HIV-infected patients were followed for neuropsychological (NP) testing during a period of almost 2 years. Tests were adjusted for age, gender, and education. Patients were divided into 5 groups: normal tests (NT), neuropsychological deficit (ND, one impaired cognitive domain), asymptomatic neurocognitive disorders (ANI), mild neurocognitive disorders (MND), and HIV-associated dementia (HAD). Risk factors for neurocognitive deterioration were analyzed. Two hundred fifty-six patients underwent NP tests and 94 participated in the follow-up. The groups were comparable. Upon neuropsychological re-testing, six patients showed clinical improvement, 30 had worsened, and 58 were stable, resulting in 42 patients presenting with HAND (45 %). The majority of HAND cases consisted of ANI (26 %) and MND (16 %). In patients whose NP performance worsened, CPE 2010 score was lower at inclusion (7.13 vs 8.00, p = 0.003) and CD4/CD8 decrease more frequent (60 vs 31 %, p = 0.008) than in those who were stable or improved. Multivariate analysis confirmed these results. A decreasing CD4/CD8 ratio during a longitudinal follow-up of randomly selected HIV-infected patients and lower CSF-penetrating regimens were independently associated with cognitive decline. Monitoring trends in CD4/CD8 ratio could contribute to identifying patients at higher risk of neurocognitive deterioration.
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39 schema:keywords CD4/CD8
40 CD4/CD8 ratio
41 CD8
42 CD8 ratio
43 CPE 2010 score
44 CSF-penetrating antiretroviral regimens
45 CSF-penetrating regimens
46 HIV
47 NP performance
48 NP test
49 activation
50 age
51 aim
52 analysis
53 antiretroviral regimens
54 asymptomatic neurocognitive disorder
55 cART era
56 cases
57 cause
58 cause of HIV
59 clinical improvement
60 cognitive decline
61 decline
62 decrease
63 deficits
64 dementia
65 deterioration
66 disorders
67 education
68 era
69 factors
70 gender
71 group
72 hand
73 hand cases
74 high risk
75 immune activation
76 impact
77 improvement
78 inclusion
79 lower CSF-penetrating antiretroviral regimens
80 lower CSF-penetrating regimens
81 majority
82 markers
83 mild neurocognitive disorder
84 multivariate analysis
85 neurocognitive deterioration
86 neurocognitive disorders
87 neuropsychological deficits
88 neuropsychological testing
89 normal tests
90 patients
91 performance
92 period
93 persistent immune activation
94 ratio
95 regimens
96 replication
97 results
98 risk
99 risk factors
100 scores
101 test
102 testing
103 time
104 trends
105 viral replication
106 years
107 schema:name A decreasing CD4/CD8 ratio over time and lower CSF-penetrating antiretroviral regimens are associated with a higher risk of neurocognitive deterioration, independently of viral replication
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