366. Severe Neurologic Impairment Persists Despite Potent ART in HIV Encephalopathy

BACKGROUND: Approximately 4–8% of the 1.1 million HIV patients in the United States have or will be diagnosed with HIV encephalopathy or HIV associated dementia (HAD). There are no published studies of the long-term outcomes of HAD treated with potent antiretroviral therapy (ART). We hypothesize that more than 60% of individuals diagnosed with HAD will have persistent neurocognitive impairment despite the successful use of potent ART and fewer than 20% will be employed. METHODS: This is a cross-sectional prospective and retrospective study of outcomes in individuals previously diagnosed with HAD. We identified all individuals with the diagnosis of dementia and HIV at the UC Infectious Diseases Center (IDC). For those who matched the 1993 CDC HAD definition, we collected medical, neurocognitive, and functional information. We attempted to contact all individuals alive and still in the IDC practice (N = 26) to perform a validated battery of neuropsychological tests. We excluded individuals with HIV-associated neurocognitive disease that developed after treatment with ART. RESULTS: We confirmed 39 diagnoses of HAD out of 137 records reviewed. The median CD4 count at the time of diagnosis of HAD was 47 cells/mm3 with a median viral load of 211,475 copies/mL. The median length of follow-up after diagnosis of HAD was 72 months (range 1–166 months). Potent ART was prescribed to all individuals, with 67.5% reaching consistent undetectable viral loads (< 200 copies/mL, occasional blips allowed). Persistent neurologic deficits were noted in 32.5%, while 60% had persistent cognitive deficits. Psychiatric disturbances were present in 72.5%. Only 2.5% reported any employment. To date, 28% have died. Ten participants have undergone formal neurocognitive testing to date (N = 26 available). The median overall summary score (total Z score) was -1.17 (range 0.08, -1.95) and median global deficit (GDS) score was 1.48 (range 0, 2.92). CONCLUSION: HIV-associated dementia results in substantial morbidity and mortality despite potent antiretroviral therapy. Prospective neurocognitive assessment documents significant impairments in most individuals. HIV-associated dementia will require additional strategies to mitigate the profound impact on the quality of life and longevity. DISCLOSURES: All authors: No reported disclosures.