Antiretroviral therapy improves neurocognitive impairment in people living with HIV? A meta-analysis.

The included evidence was observational: 2 cohort studies and 14 cross-sectional studies, so it cannot show that antiretroviral therapy caused the reported changes. The cross-sectional studies compared different people on therapy with different people off therapy, and the paper states that comparable demographic and clinical characteristics between groups are unknown. The cohort improvement came from 2 studies in Uganda involving people who were treatment-naive and had poor immune status or physical condition, so it may not apply to people who start therapy with higher CD4 counts. Different cognitive assessment tools were used across studies, and the paper says these tools have distinct sensitivities and specificities, which may have caused bias. Important confounders such as medication adherence, therapy history, comorbidities, therapy regimen, and immune status were not fully analysed because data were insufficient. Age subgroup findings were based on few studies and had high heterogeneity, so they are uncertain.

No funding was declared, and the authors report no conflicts of interest.

Do not conclude that antiretroviral therapy generally improves cognition in all people living with HIV. The positive result came only from two small cohort studies of people with advanced HIV starting treatment, while the pooled cross-sectional studies did not show better cognition in people on ART.