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In AIDS (London, England)

BACKGROUND : Although combination antiretroviral therapy reduced the prevalence of HIV-associated dementia, milder syndromes persist. Our goals were to (1) predict cognitive impairment of the Multicenter AIDS Cohort Study (MACS) participants 5 years ahead and (2) from a large pool of factors, select the ones that mostly contributed to our predictions.

DESIGN : Longitudinal, natural and treated history of HIV infection among men who have sex with men.

METHODS : The MACS is a longitudinal study of the natural and treated history of HIV disease in men who have sex with men; the neuropsychological substudy aims to characterize cognitive disorders in men with HIV disease.

RESULTS : We modelled on an annual basis the risk of cognitive impairment five years in the future. We were able to predict cognitive impairment at individual-level with high precision and overperform default methods. We found that while a diagnosis of AIDS is a critical risk factor, HIV infection per se does not necessarily convey additional risk. Other infectious processes, most notably hepatitis B and C, are independently associated with increased risk of impairment. The relative importance of an AIDS diagnosis diminished across calendar time.

CONCLUSIONS : Our prediction models are a powerful tool to help clinicians address dementia in early stages for MACS paticipants. The strongest predictors of future cognitive impairment included the presence of clinical AIDS and Hepatitis B or C infection. The fact that the pattern of predictive power differs by calendar year suggests a clinically critical change to the face of the epidemic.

Oliveira Natalia L, Kennedy Edward H, Tibshirani Ryan, Levine Andrew, Martin Eileen, Munro Cynthia, Ragin Ann B, Rubin Leah H, Sacktor Ned, Seaberg Eric C, Weinstein Andrea, Becker James T