Better executive function is independently associated with full HIV suppression during combination therapy.

• Type of Material: Article
• Authors: Albert Anderson, Emory University; Josue Pérez-Santiago, University of California San Diego; Ziduo Zheng, Emory University; Eugene Huang, Emory University; Donald Franklin, University of California San Diego; Jennifer Iudicello, University of California San Diego; David J. Moore, University of California San Diego; Ronald J. Ellis, University of California San Diego; Robert K. Heaton, University of California San Diego; Scott L. Letendre, University of California San Diego
• Language: English
• Date: 2019-12-01
• Publisher: HHS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: 2019
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/QAD.0000000000002348
• Title of Journal or Parent Work: AIDS
• Volume: 33
• Issue: 15
• Start Page: 2309
• End Page: 2316
• Keywords: Anti-HIV Agents; Humans; CD4 Lymphocyte Count; Logistic Models; HIV-1; Middle Aged; Drug Therapy, Combination; Multivariate Analysis; Prospective Studies; Male; Adult; Executive Function; Viral Load; HIV Infections; RNA, Viral; Antiretroviral Therapy, Highly Active; Female
• Research Categories: Biology, Virology; Health Sciences, Public Health

Abstract

OBJECTIVE: HIV-associated neurocognitive impairment continues to be prevalent and clinically relevant. We examined the relationship between neurocognition and full plasma HIV RNA suppression among study participants over a 15-year period at a large research program. DESIGN/METHODS: We analyzed the combined prospective studies of the HIV Neurobehavioral Research Program at the University of California at San Diego. Participants were eligible for analysis if on three drug combination antiretroviral therapy with comprehensive neuropsychological testing results. Participants who reported recent nonadherence were excluded. The primary outcome was plasma HIV RNA of 50 copies/ml or less. Generalized estimating equation was used to assess for associations with full virologic suppression taking into account longitudinal visits. RESULTS: There were 1943 participants at baseline, of whom 69.4% had plasma HIV RNA of 50 copies/ml or less. Participants with full suppression were slightly older, less likely to abuse cocaine, and had significantly better executive function. Multivariate analysis with incorporation of longitudinal visits (total = 5555) confirmed current cocaine abuse to be strongly associated with lack of virologic suppression (odds ratio = 0.45, 95% confidence interval = 0.31-0.63). In contrast, increasing age, increasing years of HIV infection, and increasing executive function (odds ratio = 1.18 for T score change of 10, 95% confidence interval = 1.07-1.30) were associated with full virologic suppression. Lack of virologic suppression at baseline was associated with a significant subsequent decline in executive function. CONCLUSION: In a 15-year research cohort of almost 2000 HIV-infected individuals on combination antiretroviral therapy, better executive function was associated with full virologic suppression, possibly as a result rather than a cause.