"We know that the virus [HIV] gets across the brain pretty quickly,
and then we think that there are these central nervous system
reservoirs, so it’s hiding out in the brain," session comoderator Dr.
Beau Ances noted in an interview. "The question is, in these individuals
with primary HIV infection, is there any kind of signature that we can
see even early on that indicates the brain is being affected? And if so,
would that affect our treatment strategy for these individuals, because
primarily, our way of diagnosing and also following an individual is
using the plasma viral load or their CD4 count."
Not
only did a sizable proportion of patients already have
neuropsychological impairments at baseline, but motor performance
continued to decline before ART initiation, he noted. Thus, the findings
may speak to a need to intervene earlier in the course of disease.
"What
was interesting was, one, these deficits are present and they are
present early in the disease. And, two, some domains seem to be
preferentially affected compared to others," Dr. Ances said.
"From
my point of view, this is very interesting in that it does bring up
some considerations as to when to start [ART] or a neuroprotective
medication," he commented. "This would suggest that maybe we need to
consider ART in these individuals and start them much earlier, since
there is damage that seems to be going on. And then targeted cognitive
rehabilitation in certain domains may be very important."
Dr. Ances is assistant professor of neurology at the Washington University School of Medicine in St. Louis. He disclosed being on the advisory committee for Lilly and working on an antidementia drug trial for Pfizer.
