A study of a Neuropsychological assessment of HIV patients on ART.

HIV infection is one of the most common health problems in modern world. Neuropsychological impairments are well described in patients with HIV infection from very early days. Prior to the antiretroviral therapy, HIV infection causing AIDS leading to dementia was high and the cumulative risk of developing HIV associated dementia was estimated between 15 – 20% in 1993. In the era of highly active anti retroviral therapy (HAART), the clinical spectrum of neuropsychological impairment changed from severe HIV associated dementia in advanced AIDS to more minor forms of neuropsychological impairment which can be managed with adequate therapy with ART and other supportive therapies. Early identification of asymptomatic neuropsychologically impaired patients by means of neurologic examination and neuropsychological assessment will be useful in the prevention and (or) reduction of neuropsychological impairment in their every day functioning of life. The neuropsychological decline in HIV patients occur in all stages of infections and it may be modified by factors like ART. So there is a growing need to find out prevalence of neuropsychological impairment and types of neuropsychological impairment in patients with HIV infection and to find out factors that will influence the occurance of neuropsychological impairment. Modification of factors that will influence neuropsychological impairment may help to improve the outcome of neuropsychological impairment in this HIV infected patients on ART. AIMS OF THE STUDY: 1. To assess the prevalence of neuropsychological impairment among HIV positive patients on AntiRetroviral Therapy (ART). 2. To study the pattern of neuropsychological impairment in the study population. 3. To study the factors that may influence the occurance of neuropsychological impairment in HIV positive patients on ART. CONCLUSION: 1. In this study, 88% of HIV patients on ART showed neuropsychological impairments. 2. The pattern of neuropsychological impairments noted in this study population include A. Attention/ working memory is affected in 62%. B. Executive function is affected in 32% . C. Divided attention is affected in 46%. D. Parietal lobar functions are affected in 26%. (calculation & constructional ability). E. Temporal lobar functions are affected in 56%.(memory). 3. Frank dementia is not observed in any of the patients studied. 4. Initial CD4 count less than 100, poor response to CD4 count improvement even after adequate duration of regular ART intake failing to increase CD4 count to more than 300 and duration of HIV infection more than 3 years and late initiation of ART are some of the factors that may contribute to disturbances in the neuropsychological functions. Neuropsychological impairments are observed in high percentage of HIV patients on ART also, causing impairments in attention/working memory, learning, executive functions, calculation and constructional ability. Initial very low CD4 count less than 100, long duration of HIV infection late initiation of ART and failure to improve CD4 count to more than 300 even after adequate duration of ART are some of the factors that may contribute to neuropsychological impairment in HIV patients on ART