6th IAS Conference On HIV Pathogenesis, Treatment and Prevention


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MOAB0103 - Oral Abstract Session

Prevalence and risk factors for HIV associated neurocognitive disorders (HAND), 1996 to 2010: results from an observational cohort

Presented by Valerio Tozzi (Italy).

P. Balestra, V. Tozzi, M. Zaccarelli, R. Libertone, G. Cataldo, G. Liuzzi, S. Menichetti, M. Giulianelli, P. Narciso, A. Antinori

I.N.M.I. L Spallanzani, Clinical Department, Rome, Italy

Background: HIV associated neurococognitive disorders (HAND) remain a prevalent condition despite HAART. We performed a 15-year survey to assess prevalence and risk factors for HAND.
Methods: Observational study of patients on ARV therapy. Patients with confounding conditions were excluded. A Neuropsychological battery of 11 tests on 5 domains was administered by one of us (PB) to all patients. For statistical analysis a logistic regression model adjusted by significant variables was used.
Results: A total of 1.375 patients were included. Calendar year was associated with a small decrease in HAND prevalence (OR=0.97; p=0.016). At unadjusted analyses, patients with HAND were older (44.8 vs 40.9 years; p< 0.0001), were older at their first HIV+ test (36.8 vs 34.5 years; p< 0.0001), had a longer exposure to HIV (8.3 vs 6.8 years; p< 0.0001), lower education (10.1 vs 12.6 years; p< 0.0001), were more likely to be HCV+ (54.7% vs 45.3%; p< 0.0001) and to be stage C CDC (58.9% vs 40.1%; p< 0.001), and had lower both current (351 vs 483; p< 0.0001) and nadir (156 vs 229; p< 0.0001) mean CD4 cells/cmm. At multivariable analyses, current CD4 (OR=0.89; 95%CI=0.89-0.96), age (OR=1.04; 95%CI=1.02-1.06), and years of education (OR=0.88; 95%CI=0.84-0.92) remained significantly associated with HAND.

HAND, n.(%)121(46.4)116(44.4)110(40.1)121(39.4)104(38.2)
Normal, n.(%)140(53.6)145(55.6)164(59.9)186(60.6)168(68.8)
Total261 (100)261 (100)274 (100)307 (100)272 (100)
[1996-2010 HAND Prevalence]

Conclusion: We observed a small downtrend in HAND prevalence across the 15-year study period. Although older age, older age at HIV acquisition, longer history of HIV infection, lower education, HCV infection, advanced disease, low current and nadir CD4 cell count were associated with HAND, age, years of education, and current CD4 showed the strongest association with HAND.

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