Neurocognitive Impairment of HIV Elite Controllers: Feature of Viral Suppression and Inflammation?

Objective: To define the neurocognitive status of elite controllers compared to well-matched treated HIV and uninfected controls.Background: HIV associated neurocognitive deficits (HAND) affect 20-50[percnt] of HIV infected individuals despite effective combination antiretroviral therapy (ART) and are speculated to be caused by persistent low-level inflammation with secondary neuronal dysfunction and injury despite effective suppression of HIV RNA. Elite controllers (EC) are a subset of HIV-infected individuals with similar undetectable plasma HIV RNA levels in the absence of ART. We used a brief test battery to examine the neurocognitive performance (NP) in a group of elites in relation to CSF and blood biomarkers of inflammation, and compared them to a group of ART-suppressed subjects (Tx) and HIV uninfected controls (NC).Methods: 12 ECs were compared cross-sectionally to 29 Tx, and 28 NC. The Tx and NC groups were matched for age, years of education and substance abuse. The Tx group was also matched for known duration of HIV infection. All subjects participated in blood and CSF studies and a battery of 4 NP tests (NPZ4). Group differences were assessed by Kruskal-Wallis with Dunn’s posttest while correlations among variables were examined using Pearson after log10 transformation of concentrations for all but CSF WBC counts.Results: While the NPZ4 scores of both the EC and Tx groups differed from those of the NC group (p u003c0.001 for both), there was no significant between these two HIV-infected groups. Using Spearman’s correlation, there was a correlation between CD8 counts (spearman9s correlation coeffiecnt r = 0.88) in ECs and NPZ4 score .Conclusions: While ECs effectively control HIV infection without cART, they exhibit neurocognitive profiles similar to the treatment-suppressed group raising the possibility of a similar pathogenesis of systemic and CSF inflammation , as an explanation for the CNS deficits in these two infected, aviremic groups. Disclosure: Dr. Bhatia has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Fuchs has nothing to disclose. Dr. Gisslen has received personal compensation for activities with Abbott, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Janssen-Cilag and Merck as a speaker and/or advisor. Dr. Zetterberg has nothing to disclose. Dr. Russell has nothing to disclose. Dr. Shacklett has nothing to disclose. Dr. Price has received personal compensation for activities with Merck u0026 Co., Inc. as a consultant and Abbvie as a speaker. Dr. Spudich has nothing to disclose.