LAUSR

HIV-associated neurocognitive disorders (HAND) continue to be reported even in patients with successful antiretroviral treatment. We investigated the prevalence of neurocognitive impairment and possible HIV-associated determinants of cognition in a Romanian cohort of young adults, parenterally infected with HIV during their first years of life. 214 treatment-experienced HIV+ individuals (median age: 24 years, males: 48%, median duration on cART: 12 years) underwent standard immunologic and virologic monitoring and antiretroviral resistance testing using pol gene sequencing in both plasma and, when available, CSF paired samples. Neurocognitive impairment was assessed using a comprehensive neuropsychological test battery and a global deficit score (GDS) was calculated (cut-off ≥ 0.5). Cognitive impairment was detected in 35% of the study participants, without any association with sex, median age, CD4 cell count (actual or nadir), CSF and plasma viral load (actual or zenith), AIDS-diagnosis, duration of HIV infection and cART characteristics. Participants carrying resistant viruses tended to be more frequently cognitively impaired (p=0.36), with a higher median GDS value (p=0.06) compared with participants harboring wild-type HIV, although the figures did not reach statistical significance. No signs of virologic compartmentalization were observed based on CSF vs plasma viral load and on the profile of pol sequences. A moderate rate of mild neurocognitive impairment is still present in young adults with chronic HIV infection acquired in early childhood despite successful cART, without any association with classic markers of HIV infection. New biomarkers reflecting persistent CNS inflammation and neuronal injury may be more relevant for the development of HAND.