Cognitive trajectories after treatment in acute HIV infection

Objective People with HIV continue to exhibit cognitive symptoms after suppressive antiretroviral therapy (ART). It remains unclear if initiating ART during acute HIV-1 infection (AHI) uniformly improves cognitive outcomes. Methods Sixty-seven individuals (96% male, median age 28 years) initiated ART immediately after AHI diagnosis and maintained viral suppression for six years. They underwent a four-test neuropsychological battery that measured fine motor speed and dexterity, psychomotor speed, and executive functioning at baseline (pre-ART AHI), weeks 12, 24, and 96, and annually thereafter through week 288. Performances were standardized to calculate an overall (NPZ-4) score and frequencies of impaired cognitive performance (≤-1 SD on ≥2 tests, or ≤-2 SD on ≥1 test). Group-based trajectory analysis (GBTA) was applied to identify distinct neuropsychological trajectories modeled from baseline to week 288. Post-hoc analyses examined HIV-1 and demographic factors that differed between trajectory subgroups. Results NPZ-4 scores improved from baseline to week 96 (p 0.5 SD and beyond practice effects. GBTA identified three NPZ-4 trajectory subgroups that all showed improvement over-time. The subgroup with lowest baseline performance exhibited worse depressive symptoms at baseline (p = 0.04) and the largest improvement among the three. HIV-1 indices did not differ between the subgroups. Conclusions Cognitive performance improved in a sustained and stable manner after initiating ART during AHI. Largest improvements were seen in participants with worst baseline cognitive performance.