|dc.description.abstract||Background: The frequency of HIV dementia in a recent study of HIV individuals at the Infectious
Disease Institute in Kampala, Uganda, was 31%. Coformulated generic drugs, which include
stavudine, are the most common regimens to treat HIV infection in Uganda and many other parts
Objective: To evaluate the benefits and risks of stavudine-based highly active antiretroviral therapy
(HAART) for HIV-associated cognitive impairment and distal sensory neuropathy. The study
compared neuropsychological performance changes in HIV individuals initiating HAART for 6
months and HIV individuals receiving no treatment for 6 months. The risk of antiretroviral toxic
neuropathy as a result of the initiation of stavudine-based HAART was also examined.
Methods: At baseline, 102 HIV individuals in Uganda received neurologic, neuropsychological,
and functional assessments; began HAART; and were followed up for 6 months. Twenty-five
HIV individuals received identical clinical assessments and were followed up for 6 months.
Results: In HIV individuals, there was improvement in verbal memory, motor and psychomotor
speed, executive thinking, and verbal fluency. After adjusting for differences in sex, HIV individuals
demonstrated significant improvement in the Color Trails 2 test (p 0.025) compared with
HIV individuals. Symptoms of neuropathy developed in 38% of previously asymptomatic HIV
patients after initiation of the stavudine-based HAART.
Conclusions: After the initiation of highly active antiretroviral therapy (HAART) including stavudine,
HIV individuals with cognitive impairment improve significantly as demonstrated by improved
performance on a test of executive function. However, peripheral neurotoxicity occurred
in 30 patients, presumably because of stavudine-based HAART, suggesting the need for less