Course Of HIV Neurologic Disease Variable, Related To Platelet Count
October 10, 2006
By Martha Kerr
(Reuters Health) - October 10, 2006 (Reuters Health)—Nearly two-thirds of patients with HIV-associated dementia have actively changing cognitive status; the neurological status in the majority of these patients deteriorates but a significant minority improves, according to data presented here at the annual meeting of the American Neurological Association.
Also, the key predictor of HIV dementia appears to be platelet count.
A multicenter team of researchers led by Dr. Justin C. McArthur of Johns Hopkins University in Baltimore assessed neurological status in a cohort of 101 patients with advanced HIV and CD4 counts below 200, measuring rates of transition of neurological disease over a 6-year period.
"HIV-associated dementia is a very strong predictor of survival," Dr. McArthur noted. "Mortality risk remains high despite the use of HAART."
Patients' neurological status was categorized as normal, mild cognitive impairment and HIV dementia.
Dr. McArthur told meeting attendees that at baseline, 49 patients had mild cognitive impairment, 18 had mild HIV dementia, 7 had moderate HIV dementia, 5 had severe HIV dementia and the remainder had normal cognitive function.
There were 71 patients available at follow-up 6 years later. During this time, 19 patients progressed from mild impairment to HIV dementia, 6 patients deteriorated from normal to mild cognitive impairment or HIV dementia.
Conversely, 19 patients improved. These patients exhibited HIV dementia at baseline but six years later, they were classified as having either mild cognitive impairment or even normal neurological status.
The researchers looked at a number of measures to predict the development of HIV dementia. "Platelet counts were a strong independent predictor," Dr. McArthur said.
A major implication of the findings are for developing counties, where current guidelines recommend beginning HAART when CD4 cell counts drop below 200 in an effort to stretch limited drug resources for HIV patients.
"We suggest this level of immunosuppression is too low for the effective prevention of HIV dementia," Dr. McArthur asserted. "Furthermore, the simplicity of platelet counts as a predictive marker of dementia suggests this may be a useful measure to identify at-risk individuals."
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