CHARTER Study

ABSTRACT

Objectives: This is a cross-sectional, observational study to determine the frequency and associated

features of HIV-associated neurocognitive disorders (HAND) in a large, diverse sample of

infected individuals in the era of combination antiretroviral therapy (CART).

Methods: A total of 1,555 HIV-infected adults were recruited from 6 university clinics across the

United States, with minimal exclusions. We used standardized neuromedical, psychiatric, and

neuropsychological (NP) examinations, and recently published criteria for diagnosing HAND and

classifying 3 levels of comorbidity (minimal to severe non-HIV risks for NP impairment).

Results: Fifty-two percent of the total sample had NP impairment, with higher rates in groups with

greater comorbidity burden (40%, 59%, and 83%). Prevalence estimates for specific HAND

diagnoses (excluding severely confounded cases) were 33% for asymptomatic neurocognitive

impairment, 12% for mild neurocognitive disorder, and only 2% for HIV-associated dementia

(HAD). Among participants with minimal comorbidities (n   843), history of low nadir CD4 was a

strong predictor of impairment, and the lowest impairment rate on CART occurred in the subset

with suppressed plasma viral loads and nadir CD4  200 cells/mm3 (30% vs 47% in remaining

subgroups).

Conclusions: The most severe HAND diagnosis (HAD) was rare, but milder forms of impairment

remained common, even among those receiving CART who had minimal comorbidities. Future

studies should clarify whether early disease events (e.g., profound CD4 decline) may trigger

chronic CNS changes, and whether early CART prevents or reverses these changes. Neurology®

2010;75:2087–2096