The Impacts of Pre-cART versus cART Era on HIV-associated Neurocognitive Disorders: A Meta-Analysis

Objectives: The objective of this presentation is a systematic literature review to consider HIV-associated neurocognitive disorder (HAND) rates before and during the cART era. Background This paper is a combination of literature reviews, observational studies, prospective studies and retrospective studies. A second objective of this systematic review is to identify and summarize recent studies that examine asymptomatic neurocognitive impairment in HAND during pre-cART and cART era. Methods: A systematic literature review was conducted to include English-language articles published from 2009 to 2019 on July 19th, 2019. A total of four electronic databases were used including MEDLINE, PUBMED, EMBASE, and PsycINFO and were searched to identify potentially relevant articles. The search combined free text and MeSH terms with HIV-associated neurocognitive AND combination antiretroviral therapy with asymptotic neurocognitive impairment OR mild cognitive disorder OR HIV-associated dementia. From these results, a meta-analysis was conducted using STATA, a software package used for interactive, or batched, statistical analysis. Results: Despite enhanced research efforts and effective cART, a high prevalence of HAND within the HIV-infected population remains. Although the most severe form of HAND, HIV associated dementia (HAD) is much less common in cART era, researchers still pose questions about any long-term benefit of cART with respect to milder forms of HAND. Preliminary findings have shown that patients with ANI will progress more quickly to more severe forms of HAND than those without ANI. Given this, the relevance of the correct diagnosis of ANI is crucial where well over 50% of all HIV-infected patients suffer from some stage of HAND mentioned above. Conclusions: There are various social, economic, and public health implications surrounding HAND. The burden of disease is increasing at an exponential rate but we are still unaware of the long-term survival with chronic immune activation. Future studies should assess the will this impact the aging population, the role of medication adherence, and the impact of comorbidities affect on HAND. Grants- HPD Grant, NIH Exploratory/Developmental Research Grant Award (R21) R25MH083617-0