TY - JOUR
T1 - Neurocognitive function in HIV-infected persons with asymptomatic cryptococcal antigenemia
T2 - A comparison of three prospective cohorts
AU - Montgomery, Martha P.
AU - Nakasujja, Noeline
AU - Morawski, Bozena M.
AU - Rajasingham, Radha
AU - Rhein, Joshua
AU - Nalintya, Elizabeth
AU - Williams, Darlisha A.
AU - Huppler Hullsiek, Kathy
AU - Kiragga, Agnes
AU - Rolfes, Melissa A.
AU - Donahue Carlson, Renee
AU - Bahr, Nathan C.
AU - Birkenkamp, Kate E.
AU - Manabe, Yukari C.
AU - Bohjanen, Paul R.
AU - Kaplan, Jonathan E.
AU - Kambugu, Andrew
AU - Meya, David B.
AU - Boulware, David R.
AU - and on behalf of the COAT and ORCAS Trial Teams
N1 - Publisher Copyright:
© 2017 The Author(s).
PY - 2017/6/12
Y1 - 2017/6/12
N2 - Background: HIV-infected persons with detectable cryptococcal antigen (CrAg) in blood have increased morbidity and mortality compared with HIV-infected persons who are CrAg-negative. This study examined neurocognitive function among persons with asymptomatic cryptococcal antigenemia. Methods: Participants from three prospective HIV cohorts underwent neurocognitive testing at the time of antiretroviral therapy (ART) initiation. Cohorts included persons with cryptococcal meningitis (N = 90), asymptomatic CrAg + (N = 87), and HIV-infected persons without central nervous system infection (N = 125). Z-scores for each neurocognitive test were calculated relative to an HIV-negative Ugandan population with a composite quantitative neurocognitive performance Z-score (QNPZ-8) created from eight tested domains. Neurocognitive function was measured pre-ART for all three cohorts and additionally after 4 weeks of ART (and 6 weeks of pre-emptive fluconazole) treatment among asymptomatic CrAg + participants. Results: Cryptococcal meningitis and asymptomatic CrAg + participants had lower median CD4 counts (17 and 26 cells/μL, respectively) than the HIV-infected control cohort (233 cells/μL) as well as lower Karnofsky performance status (60 and 70 vs. 90, respectively). The composite QNPZ-8 for asymptomatic CrAg + (-1.80 Z-score) fell between the cryptococcal meningitis cohort (-2.22 Z-score, P = 0.02) and HIV-infected controls (-1.36, P = 0.003). After four weeks of ART and six weeks of fluconazole, the asymptomatic CrAg + cohort neurocognitive performance improved (-1.0 Z-score, P < 0.001). Conclusion: Significant deficits in neurocognitive function were identified in asymptomatic CrAg + persons with advanced HIV/AIDS even without signs or sequelae of meningitis. Neurocognitive function in this group improves over time after initiation of pre-emptive fluconazole treatment and ART, but short term adherence support may be necessary.
AB - Background: HIV-infected persons with detectable cryptococcal antigen (CrAg) in blood have increased morbidity and mortality compared with HIV-infected persons who are CrAg-negative. This study examined neurocognitive function among persons with asymptomatic cryptococcal antigenemia. Methods: Participants from three prospective HIV cohorts underwent neurocognitive testing at the time of antiretroviral therapy (ART) initiation. Cohorts included persons with cryptococcal meningitis (N = 90), asymptomatic CrAg + (N = 87), and HIV-infected persons without central nervous system infection (N = 125). Z-scores for each neurocognitive test were calculated relative to an HIV-negative Ugandan population with a composite quantitative neurocognitive performance Z-score (QNPZ-8) created from eight tested domains. Neurocognitive function was measured pre-ART for all three cohorts and additionally after 4 weeks of ART (and 6 weeks of pre-emptive fluconazole) treatment among asymptomatic CrAg + participants. Results: Cryptococcal meningitis and asymptomatic CrAg + participants had lower median CD4 counts (17 and 26 cells/μL, respectively) than the HIV-infected control cohort (233 cells/μL) as well as lower Karnofsky performance status (60 and 70 vs. 90, respectively). The composite QNPZ-8 for asymptomatic CrAg + (-1.80 Z-score) fell between the cryptococcal meningitis cohort (-2.22 Z-score, P = 0.02) and HIV-infected controls (-1.36, P = 0.003). After four weeks of ART and six weeks of fluconazole, the asymptomatic CrAg + cohort neurocognitive performance improved (-1.0 Z-score, P < 0.001). Conclusion: Significant deficits in neurocognitive function were identified in asymptomatic CrAg + persons with advanced HIV/AIDS even without signs or sequelae of meningitis. Neurocognitive function in this group improves over time after initiation of pre-emptive fluconazole treatment and ART, but short term adherence support may be necessary.
KW - AIDS dementia complex
KW - Cryptococcal meningitis
KW - Cryptococcus
KW - HIV
KW - Neurocognitive disorders
KW - Neuropsychological tests
UR - http://www.scopus.com/inward/record.url?scp=85020452637&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85020452637&partnerID=8YFLogxK
U2 - 10.1186/s12883-017-0878-2
DO - 10.1186/s12883-017-0878-2
M3 - Article
C2 - 28606065
AN - SCOPUS:85020452637
SN - 1471-2377
VL - 17
JO - BMC neurology
JF - BMC neurology
IS - 1
M1 - 110
ER -