Improved neurocognitive test performance in both arms of the SMART study: impact of practice effect

• Published in: Journal of neurovirology 2013-08, Vol.19 (4), p.383-392
• Main Authors: Grund, Birgit, Wright, Edwina J., Brew, Bruce J., Price, Richard W., Roediger, Mollie P., Bain, Margaret P., Hoy, Jennifer F., Shlay, Judith C., Vjecha, Michael J., Robertson, Kevin R.
• Format: Article
• Language: English
• Subjects: Adult; AIDS Dementia Complex - prevention & control; Anti-Retroviral Agents - administration & dosage; Biomedical and Life Sciences; Biomedicine; Female; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Immunology; Infectious Diseases; Learning; Male; Middle Aged; Neurology; Neuropsychological Tests; Neurosciences; Virology
• ISSN: 1355-0284; 1538-2443
• DOI: 10.1007/s13365-013-0190-x

We evaluated factors associated with improvement in neurocognitive performance in 258 HIV-infected adults with baseline CD4 lymphocyte counts above 350 cells/mm 3 randomized to intermittent, CD4-guided antiretroviral therapy (ART) (128 participants) versus continuous therapy (130) in the Neurology substudy of the Strategies for Management of Antiretroviral Therapy trial. Participants were enrolled in Australia, North America, Brazil, and Thailand, and neurocognitive performance was assessed by a five-test battery at baseline and month 6. The primary outcome was change in the quantitative neurocognitive performance z score (QNPZ-5), the average of the z scores of the five tests. Associations of the 6-month change in test scores with ART use, CD4 cell counts, HIV RNA levels, and other factors were determined using multiple regression models. At baseline, median age was 40 years, median CD4 cell count was 513 cells/mm 3 , 88 % had plasma HIV RNA ≤400 copies/mL, and mean QNPZ-5 was −0.68. Neurocognitive performance improved in both treatment groups by 6 months; QNPZ-5 scores increased by 0.20 and 0.13 in the intermittent and continuous ART groups, respectively (both P