Background:  HAART has resulted in increased survival of HIV infected patients and in a decreased incidence of HIV Dementia, but the impact of treatment with CSF penetrating drugs on HIV associated neurocognitive impairment in routine practice deserves more attention.

Methods: Cross-sectional study on HIV-infected patients exposed to the same HAART regimen for at least six months who underwent neuropsychological testing. Potential confounders (alcohol or drug abuse and concomitant neurological disorders) and patients with severe HIV dementia were excluded. Zidovudine, stavudine, lamivudine, abacavir, nevirapine, and indinavir were considered drugs with good CSF penetration. Patients were classified as neurocognitively impaired or unimpaired according to their neurocognitive performance adjusted for age and education. For statistics crude and adjusted OR by logistic regression was employed.

Results: We evaluated 165 HIV-1-infected patients from 1996 to 2003. Characteristics of patients: male sex 72.7%, IVDU 62.4%, sexual transmission 36.4%, previous AIDS defining event 38.8%, median age 40 (IQR 36-47), median CD4 cell count 401 cell/mL (IQR 235-652), median plasma HIV RNA 2.02 log₁₀ copies/mL (IQR 1.69 to 3.34). 13.3% of patients received 1, 45.5% 2, 41.2% 3 or more CSF penetrating drug. In 50.3% of patients neuropsychological testing resulted abnormal. Neither class of antiretroviral agents nor single nor multiple drugs having good CSF penetration were associated with the increased risk of abnormal neuropsychological performance. Older age (for 10 years increase OR 4.8, 95 % CI 2.2 to 10.4, p <0.0001) and higher plasma HIV-1 RNA levels (OR 1.90, 95% CI 1.1 to 3.2, p = 0.002) were independently associated with an increased probability of impaired neurocognitive performance, while higher education was a protective factor (OR 0.76, 95% CI 0.65 to 0.90, p = 0.001). No significant effect on cognitive impairment for CD4 cell count, previous AIDS defining event, HCV co-infection, haemoglobin levels was observed.

Conclusions:  With the limit of cross-sectional approach our study indicates that the use of stable HAART containing multiple CSF penetrating drugs was not associated with normal neuropsychological performance. In these patients plasma HIV-1 replication is the only HIV-related factor independently associated with neuropsychological disorders.

Keywords: neurocognitive; HAART; CSF