Details

Autor(en) / Beteiligte

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

Titel

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

Ist Teil von

• Journal of neurovirology, 2017-04, Vol.23 (2), p.216-225

Ort / Verlag

Cham: Springer International Publishing

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.