Establishment of a Multi-Disciplinary Platform for HIV-Infected Patients with Neurological Complications (P4.310)

OBJECTIVE: To describe the functioning and clinical results of the first multi-disciplinary neuro-HIV platform for HIV-infected patients in Switzerland. BACKGROUND: Despite the availability of combination antiretroviral therapy (cART), neurological complications, in particular the cognitive ones, remain a challenge in HIV-infected patients. Frequently, co-morbidities are intermingled with HIV, rendering the diagnostic and therapeutic procedures difficult in these patients. DESIGN/METHODS: In March 2011, we set up, at the Lausanne University Hospital, a multi-disciplinary Neuro-HIV Platform composed of infectiologists, neurologists, neuropsychologists, psychiatrists, and neuroradiologists. During a day-hospitalization, the patient benefits from a clinical evaluation by all these specialists, together with blood work-up, brain MRI and lumbar puncture. At the end of the day, diagnosis and treatment plan are discussed by the whole team. RESULTS: From March 2011 to September 2013, we evaluated 75 consecutive patients (49 men, 49.8±9.3 y, nadir CD4+ T cells 170.8±143.8 cells/mm 3 , current CD4 + 569.9±258 cells/mm 3 , 75% with undetectable plasma HIV RNA, 90% with undetectable CSF viral load, 99% on cART, revised CPE score 7.6±1.6). Main referral cause was cognitive complaints (89%), which were confirmed in 78% of those. The leading causes of cognitive disorders were psychiatric conditions (44% of all the confirmed) and HIV-associated neurocognitive disorders (HAND) (29%). Neurological deficits were evidenced in 47% of the total cohort (central signs in 20%; peripheral signs in 27%). Brain MRI was abnormal in 52%, mostly due to slight to moderate cortical/subcortical atrophy. The presence of HAND was correlated with a lower nadir CD4+ T cells (p=0.007). No other correlation was found between HIV disease status and neurological deficits. CONCLUSIONS: Neurological/neuropsychological complications are frequent in well-treated HIV+ patients, consisting mainly in cognitive disorders. The latter are more often ascribed to a psychiatric condition than to HIV infection itself. A multi-disciplinary approach is a real asset to take care of these complex patients. Study Supported by: We are indebted to AbbVie, Gilead, Bristo-Myers Squibb who made this Neuro-HIV platform possible. Disclosure: Dr. Du Pasquier has received personal compensation for activities with Biogen Idec, Novartis, Abbott, ViiV, Merck Serono, and Merck Sharp & Dohme Ltd. Dr. Simioni has nothing to disclose. Dr. Alves has nothing to disclose. Dr. Meuli has nothing to disclose. Dr. Maccaferri has nothing to disclose. Dr. Berney has nothing to disclose. Dr. Cavassini has received research support from Merck Sharp & Dohme Ltd., and Gilead.