Three-decade neurological and neurocognitive follow-up of HIV-1-infected patients on best-available antiretroviral therapy in Finland

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Heikinheimo-Connell , T , Poutiainen , E , Salonen , O , Elovaara , I & Ristola , M A 2015 , ' Three-decade neurological and neurocognitive follow-up of HIV-1-infected patients on best-available antiretroviral therapy in Finland ' , BMJ Open , vol. 5 , no. 11 , 007986 . https://doi.org/10.1136/bmjopen-2015-007986

Title: Three-decade neurological and neurocognitive follow-up of HIV-1-infected patients on best-available antiretroviral therapy in Finland
Author: Heikinheimo-Connell, T.; Poutiainen, E.; Salonen, O.; Elovaara, I.; Ristola, Matti A
Contributor: University of Helsinki, Clinicum
University of Helsinki, Neurologian yksikkö
University of Helsinki, Clinicum
University of Helsinki, Clinicum
Date: 2015
Language: eng
Number of pages: 7
Belongs to series: BMJ Open
ISSN: 2044-6055
URI: http://hdl.handle.net/10138/161894
Abstract: Objectives: Is it possible to live without neurocognitive or neurological symptoms after being infected with HIV for a very long time? These study patients with decades-long HIV infection in Finland were observed in this follow-up study during three time periods: 1986-1990, in 1997 and in 2013. Setting: Patients from greater Helsinki area were selected from outpatient's unit of infectious diseases. Participants: The study included 80 HIV patients. Patients with heavy alcohol consumption, central nervous system disorder or psychiatric disease were excluded. Primary and secondary outcome measures: The patients underwent neurological and neuropsychological examinations, MRI of the brain and laboratory tests, including blood CD4 cells and plasma HIV-1 RNA. Neuropsychological examination included several measures: subtests of Wechsler Adult Intelligence Scale, Wechsler Memory Scale-Revised, list learning, Stroop and Trail-Making-B test. The Beck Depression Inventory and Fatigue Severity Scale were also carried out. The obtained data from the three time periods were compared with each other. Results: Owing to high mortality among the original 80 patients, eventually, 17 participated in all three examinations performed between 1986 and 2013. The time from the HIV diagnosis was 27 (23-30) years. Blood CD4 cells at the diagnosis were 610 (29-870) cells/mm(3), and the nadir CD4 168 (4-408) cells/mm(3). The time on combined antiretroviral treatment was 13 (5-17) years. 9 patients suffered from fatigue, 5 had polyneuropathy and 3 had lacunar cerebral infarcts. There was a subtle increase of brain atrophy in 2 patients. Mild depressive symptoms were common. The neuropsychological follow-up showed typical age-related cognitive changes. No HIV-associated dementia features were detected. Conclusions: Polyneuropathy, fatigue and mild depression were common, but more severe neurological abnormalities were absent. These long-term surviving HIV-seropositive patients, while on best-available treatment, showed no evidence of HIV-associated neurocognitive disorder in neuropsychological and neuroradiological evaluations.
Subject: CEREBROSPINAL-FLUID
MULTIPLE-SCLEROSIS
HIV-1 INFECTION
RISK-FACTORS
HEPATITIS-C
DISORDERS
SEVERITY
BRAIN
ERA
IMPAIRMENT
3121 General medicine, internal medicine and other clinical medicine
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