Cognitive disorders in HIV-infected patients: are they HIV-related?

AIDS. 2013 Jan 28;27(3):391-400. doi: 10.1097/QAD.0b013e32835b1019.


Objectives: Large unselected studies on representative samples of HIV-infected patients with a whole battery of neuropsychological tests and cerebral MRI scan are required to assess the frequency of neurocognitive impairment (NCI), the determinants of mild neurocognitive disorders (MNDs), or HIV-associated dementia (HAD) and the relationship between NCI and MRI scan findings.

Methods: Investigation of 400 consecutively enrolled HIV-1-infected adults from the ANRS CO3 Aquitaine Cohort, using standardized neurocognitive tests chosen to achieve consistency with Frascati's criteria. Half of the patients had a cerebral MRI scan allowing gray and white matter volume measurement. Factors associated with NCI were studied by logistic regression models.

Results: Median age of participants was 47 years, 79% were male and 89% received combination antiretroviral treatment (cART), of whom 93% had plasma HIV RNA below 500 copies/ml. Median CD4 cell count was 515 cells/μl. Prevalence of NCI was 59%, including 21% of asymptomatic NCI, 31% of MND, and 7% of HAD. A low level of education, prior neurologic AIDS-defining disorders event, anxiety, depressive symptoms, and prior history of brain damage were independently associated with MND or HAD, but neither HIV nor cART-related variables. The presence of NCI was significantly associated with lower gray matter fraction.

Interpretation: In this large unselected cohort, a high prevalence of symptomatic neurocognitive disorders was mainly related to its traditional determinants and associated with gray matter atrophy at early stages of the disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS Dementia Complex / epidemiology
  • AIDS Dementia Complex / pathology*
  • Antiretroviral Therapy, Highly Active
  • Atrophy
  • Body Mass Index
  • Brain / pathology*
  • Brain / virology
  • CD4 Lymphocyte Count
  • Cognition Disorders / epidemiology
  • Cognition Disorders / pathology*
  • Cognition Disorders / virology
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • HIV Infections / epidemiology
  • HIV Infections / pathology*
  • Humans
  • Logistic Models
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Prevalence
  • RNA, Viral / blood
  • RNA, Viral / isolation & purification
  • Surveys and Questionnaires


  • RNA, Viral