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Homearrow News and Events Year 2013 Delay in HIV treatment may affect cognition, motor skills

Delay in HIV treatment may affect cognition, motor skills

Performing routine activities like cooking, bathing and walking may become difficult for an HIV–infected person if treatment is delayed, a firstof–its–kind study has found.

The five–year–long study, conducted by the Pune–based National AIDS Research Institute (NARI) along with HIV Neurobehavioral Research Programme at the University of California, San Diego, found that people with HIV/ AIDS in India are at higher risk of developing milder neuro–cognitive impairment if treatment is not initiated. The study was completed in May this year.

The study has indicated a higher baseline prevalence (47%) of neuro–cognitive impairment in people with advanced HIV infection who are yet to take treatment. Neurocognitive impairment affects cognition (thinking), motor control (body movements) and the psychological state of the individual.

The world over, people with HIV infection are living longer and having a better quality of life due to greater access to antiretroviral therapy (ART). Thanks to ART, HIVinduced illnesses like cryptococal meningitis have been on the decline. However, conditions like HIV–associated neuro–cognitive disorder (HAND) are still prevalent.

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The study also assumes significance as earlier studies in the western world were based on the subtype B virus that causes HIV infection. However, in India, clade C is the most common subtype. Based on its characteristics, clade C has been found to affect an individual’s nervous system less severely than other subtypes. It was milder than the subtype B prevalent in Europe and America, researchers say.

"The baseline finding of the study suggests that clinicians and healthcare providers must know if people living with HIV have any difficulties with cognition or performing daily activities. The family members or the caregivers should also be told of such conditions so that they can detect changes in the individual and seek timely advice from healthcare providers," researcher Manisha Ghate, co–principal investigator of the study, told TOI on Thursday.

Ghate said, "The routine activities of HIV–infected people may get affected if they have neuro–cognitive impairment. In milder forms, it may be prominent only while performing complex tasks like calculations and multitasking. But it is pronounced in severe forms like dementia and patients may have difficulty even in performing routine daily activities like cooking, bathing and walking. Cognitive impairment associated with HIV has been correlated with the increased complaints of job performance difficulties and poor medication adherence."

Researcher Sanjay Mehendale, the principal investigator of the study, said, "The beneficial effect of ART has been observed in cognitively impaired individuals. The improvement was seen in the domains of learning, executive functioning and motor performance. This beneficial effect was also observed in cognitively impaired individuals with higher CD4 counts."

Even otherwise, healthy people show neurological decline as they age. "But here we have a younger population infected with HIV, so this effect will be greater as they age. Patients need counselling in addition to ART," Ghate said.

When contacted, NARI director Ramesh Paranjape said, "This is the first comprehensive study in India which has additionally evaluated viral and host factors associated with neuro–cognitive impairments in people with HIV."

WHY THE STUDY?

People with HIV infection are living longer and better due to improved access to antiretroviral therapy. Though neurological opportunistic infections are on decline, non opportunistic conditions like HIV associated neurocognitive impairment (HAND) remain prevalent.

It has been shown that the impaired cognitive performance can affect routine activities, employment, adherence to treatment and quality of life. The studies have been conducted globally, but the data on the prevalence and co–factors associated with HAND available from systematically conducted research in India is scanty.

STUDY DETAILS
  • This is the first comprehensive study in India which has additionally evaluated viral and host factors associated with neuro–cognitive impairments in people with HIV.
  • Pune–based National AIDS Research Institute (NARI) along with HIV Neurobehavioral Research Programme at the University of California, San Diego.
  • The study was initiated in September 2008 and completed recently in May 2013.
  • The study was conducted in adult population above 18 years of age.
  • The data was collected in three groups: 1) HIV infected individuals with advanced disease (CD4 count less than 200 cells/cmm) : [number of patients were 125], 2) HIV infected individuals with CD4 count between 350–550 cells/cmm : [number of patients were 128] and 3) HIV uninfected individuals [number of patients were 287]. t All participants received a comprehensive neuropsychological evaluation, neuromedical assessment and laboratory evaluation.
  • The neuropsychological test battery that was used in this study was developed at HIV Neurobehavioral Research Center (HNRC) San Diego and standardized in Indian population prior to use
  • After baseline evaluations, all individuals with CD4 count less than 200 cells/mm3 received ART treatment as per the national guidelines and nearly 50% HIV individuals with CD4 count between 350 and 550 cells/mm3 were given immediate antiretroviral treatment (they were co enrolled from a ongoing clinical trial).
  • The participants were followed every year for neuropsychological evaluation. The cognitive battery included tests in the domain of fluency, speed of information processing, attention, executive functioning,learning, memory and motor performance.
  • The outcome on ART was evaluated based on the performance in these tests.
IN THE OFFING
  • Indian Council of Medical Research has organised national seminar on ‘NeuroAIDS in India: Current Findings and Future Directions’ at National AIDS Research Institute (NARI) in Pune on September 24 and September 25.
(Source: National AIDS Research Institute (NARI), Pune) KEY FINDINGS OF NARI STUDY
  • A study has indicated higher baseline prevalence (47%) of neuro cognitive impairment in people with advanced HIV infection who are yet to be put on treatment
  • The most common subtype clade C, which causes HIV infection in India, has been found to affect nervous system less severely than subtypes like subtype B virus prevalent in Europe, America

Source
Times of India
23 August 2013, Pune.

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