Neurocognitive function in HIV-infected persons with asymptomatic cryptococcal antigenemia: a comparison of three prospective cohorts.
Background: HIV-infected persons with detectable cryptococcal antigen (CrAg) in blood have increased morbidity and mortality compared with HIV-infected persons who are CrAg-negative. This study examined neurocognitive function among persons with asymptomatic cryptococcal antigenemia.Methods: Partici...
| Publicado en: | BMC Neurology Vol. 17; pp. 1 - 10 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
BioMed Central
6/12/2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123618691&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 123618691 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14712377 1CI7 jtl: BMC Neurology issn: 14712377 maglogo: N pubinfo: dt: 6/12/2017 vid: 17 pid: 24147 pub: BioMed Central artinfo: ui: 123618691 123618691 NLM28606065 123618691 10.1186/s12883-017-0878-2 NLM28606065 123618691 ppf: 1 ppct: 9 formats: tig: atl: Neurocognitive function in HIV-infected persons with asymptomatic cryptococcal antigenemia: a comparison of three prospective cohorts. aug: au: Montgomery, Martha P. Nakasujja, Noeline Morawski, Bozena M. Rajasingham, Radha Rhein, Joshua Nalintya, Elizabeth Williams, Darlisha A. Hullsiek, Kathy Huppler Kiragga, Agnes Rolfes, Melissa A. Carlson, Renee Donahue Bahr, Nathan C. Birkenkamp, Kate E. Manabe, Yukari C. Bohjanen, Paul R. Kaplan, Jonathan E. Kambugu, Andrew Meya, David B. Boulware, David R. Huppler Hullsiek, Kathy affil: Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, 3-222 MTRF, 2001 6th St SE, Minneapolis, MN 55455, USA sug: subj: Cryptococcus HIV Infections Complications Meningitis, Cryptococcal Diagnosis Antigens, Fungal Female Prospective Studies Adult Male Human Funding Source Adult: 19-44 years Female Male ab: Background: HIV-infected persons with detectable cryptococcal antigen (CrAg) in blood have increased morbidity and mortality compared with HIV-infected persons who are CrAg-negative. This study examined neurocognitive function among persons with asymptomatic cryptococcal antigenemia.Methods: Participants from three prospective HIV cohorts underwent neurocognitive testing at the time of antiretroviral therapy (ART) initiation. Cohorts included persons with cryptococcal meningitis (N = 90), asymptomatic CrAg + (N = 87), and HIV-infected persons without central nervous system infection (N = 125). Z-scores for each neurocognitive test were calculated relative to an HIV-negative Ugandan population with a composite quantitative neurocognitive performance Z-score (QNPZ-8) created from eight tested domains. Neurocognitive function was measured pre-ART for all three cohorts and additionally after 4 weeks of ART (and 6 weeks of pre-emptive fluconazole) treatment among asymptomatic CrAg + participants.Results: Cryptococcal meningitis and asymptomatic CrAg + participants had lower median CD4 counts (17 and 26 cells/μL, respectively) than the HIV-infected control cohort (233 cells/μL) as well as lower Karnofsky performance status (60 and 70 vs. 90, respectively). The composite QNPZ-8 for asymptomatic CrAg + (-1.80 Z-score) fell between the cryptococcal meningitis cohort (-2.22 Z-score, P = 0.02) and HIV-infected controls (-1.36, P = 0.003). After four weeks of ART and six weeks of fluconazole, the asymptomatic CrAg + cohort neurocognitive performance improved (-1.0 Z-score, P < 0.001).Conclusion: Significant deficits in neurocognitive function were identified in asymptomatic CrAg + persons with advanced HIV/AIDS even without signs or sequelae of meningitis. Neurocognitive function in this group improves over time after initiation of pre-emptive fluconazole treatment and ART, but short term adherence support may be necessary. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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