Neuropsychological Impairment in Acute HIV and the Effect of Immediate Antiretroviral Therapy

J Acquir Immune Defic Syndr. 2015 Dec 1;70(4):393-9. doi: 10.1097/QAI.0000000000000746.


Objective: To investigate neuropsychological performance (NP) during acute HIV infection (AHI) before and after combination antiretroviral therapy (cART).

Design: Prospective study of Thai AHI participants examined at 3 and 6 months after initiation of cART.

Methods: Thirty-six AHI participants were evaluated pre-cART at median 19 days since HIV exposure and 3 and 6 months after cART with the Grooved Pegboard test, Color Trails 1 & 2 (CT1, CT2), and Trail Making Test A. Raw scores were standardized to 251 age- and education-matched HIV-uninfected Thais. To account for learning effects, change in NP performance was compared with that of controls at 6 months. Analyses included multivariable regression, nonparametric repeated measures analysis of variance, and Mann-Whitney U test.

Results: Baseline NP scores for the AHI group were within normal range (z-scores range: -0.26 to -0.13). NP performance improved on CT1, CT2, and Trail Making Test A in the initial 3 months (P < 0.01) with no significant change during the last 3 months. Only improvement in CT1 was greater than that seen in controls at 6 months (P = 0.018). Participants who performed >1 SD below normative means on ≥2 tests (n = 8) exhibited higher baseline cerebrospinal fluid HIV RNA (P = 0.047) and had no improvement after cART.

Conclusions: Most AHI individuals had normal NP performance, and early cART slightly improved their psychomotor function. However, approximately 25% had impaired NP performance, which correlated with higher cerebrospinal fluid HIV RNA, and these abnormalities were not reversed by early cART possibly indicating limited reversibility of cognitive impairment in a subset of AHI individuals.

Publication types

  • Clinical Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anti-Retroviral Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / pathology*
  • HIV Infections / psychology*
  • Humans
  • Longitudinal Studies
  • Male
  • Nervous System Diseases / drug therapy*
  • Nervous System Diseases / pathology*
  • Neuropsychological Tests
  • Prospective Studies
  • Psychomotor Disorders / drug therapy*
  • Psychomotor Disorders / physiopathology*
  • Thailand
  • Treatment Outcome
  • Young Adult


  • Anti-Retroviral Agents