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Does Antiretroviral Therapy Improve HIV-Associated Cognitive Impairment? A Quantitative Review of the Literature

Published online by Cambridge University Press:  04 August 2011

Timour Al-Khindi ,
Konstantine K. Zakzanis  and
Wilfred G. van Gorp
Timour Al-Khindi
Affiliation:
Department of Psychology, University of Toronto Scarborough, Toronto, Ontario
Konstantine K. Zakzanis*
Affiliation:
Department of Psychology, University of Toronto Scarborough, Toronto, Ontario
Wilfred G. van Gorp
Affiliation:
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
*
Correspondence and reprint requests to: Konstantine K. Zakzanis, Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada. E-mail: [email protected]
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Abstract

The development of antiretroviral therapy (ART) has dramatically improved survival for those living with human immunodeficiency virus (HIV), but whether ART improves cognitive functioning remains unclear. The aim of the present review was to examine systematically the extent to which ART improves cognition among individuals with HIV using meta-analytic methods. Twenty-three studies were included in the quantitative review. ART was associated with modest improvements in attention (mean d = .17; p < .001; 95% confidence interval [CI], .09/.25), executive function (mean d = .18; p < .001; 95% CI, .10/.26), and motor function (mean d = .24; p < .001; 95% CI, .16/.32). ART did not improve language, verbal memory, visual memory or visuospatial function. The extent to which cognition improved was correlated with the change in CD4 cell count following ART, suggesting a link between cognitive outcome and immune system integrity. Together, the present findings indicate that the neuropsychological test performance of most HIV patients taking ART is comparable to those not taking ART. Development of pharmaceutical treatments and rehabilitation strategies that target the cognitive effects of HIV infection is needed. (JINS, 2011, 17, 956–969)

Keywords

Acquired immune deficiency syndromeAntiretroviral therapyCognitive outcomeHuman immunodeficiency virusMeta-analysisNeuropsychological assessment
Type
Critical Review
Information
Journal of the International Neuropsychological Society , Volume 17 , Issue 6 , November 2011 , pp. 956 - 969
Copyright
Copyright © The International Neuropsychological Society 2011

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