OBJECTIVE: To rigorously evaluate the time course of cognitive change in a cohort of individuals with HIV-associated neurocognitive disorders (HAND) initiating combination antiretroviral therapy (CART), and to investigate which demographic, laboratory, and treatment factors are associated with neuropsychological (NP) outcome (or "any NP improvement"). METHODS: Study participants included 37 HIV+ individuals with mild to moderate NP impairment who initiated CART and underwent NP testing at 12, 24, 36, and 48 weeks thereafter. NP change was assessed using a regression-based change score that was normed on a separate NP-stable group thereby controlling for regression toward the mean and practice effect. Mixed-effect regression models adjusting for loss to follow-up were used to evaluate the time course of cognitive change and its association with baseline and time-varying predictors. RESULTS: In persons with HAND initiating CART, cognitive improvement happens soon after initiation (13% at week 12), but more often 24, 36, and up to 48 weeks after initiation (up to 41%), with fewer than 5% demonstrating significant worsening. In multivariate analyses, unique predictors of NP improvement included more severe baseline NP impairment and higher CART CNS penetration index. Greater viral load decrease was associated with NP improvement only in univariate analyses. CONCLUSION: Clinically meaningful neuropsychological improvement seemed to peak around 24-36 weeks after combination antiretroviral therapy initiation and was prolonged over the 1-year study period. This study also provides new evidence that benefit may be maximized by choosing antiretroviral medications that reach therapeutic concentrations in the CNS.

Neurology. 2009 May 27. Cysique LA, Vaida F, Letendre S, Gibson S, Cherner M, Woods SP, McCutchan JA, Heaton RK, Ellis RJ. >From the Department of Psychiatry (L.A.C., M.C., S.P.W., R.K.H.), Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine (F.V.), Department of Medicine (S.L., S.G., J.A.M.), and Department of Neurosciences (R.J.E.), University of California at San Diego; and Brain Sciences (L.A.C.), University of New South Wales, Sydney, Australia.

Pauline is a Registered Nurse with over 24 years experience in the obstetrics field. Pauline's areas of expertise include enhancing fertility, healthy pregnancy, childbirth and HypnoBirthing, grief resolution due to pregnancy and infant loss, help with post partum depression, pre and post surgical relaxation and healing, fighting cancer, eliminating stress, anxiety and fear, enhancing relaxation, pain management, weight management, smoking cessation, and studying. Pauline gave a presentation to the Association of Women's Health, Obstetric and Neonatal Nursing on September 29, 2006. The focus of the presentation was how hypnosis can help during pregnancy, childbirth and beyond. Nurses learned how and why hypnosis works. They also learned how Evidence Based Practice and Hypnosis complement each other beautifully to ensure a good outcome for both the mom and the baby.

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