Long‐Term Neurologic Exam Findings in People Diagnosed and Treated During Acute <scp>HIV</scp> Infection

OBJECTIVE: Evaluate clinical and laboratory correlates of abnormal neurologic exam findings after acute HIV infection (AHI). METHODS: Participants from the RV254/SEARCH 010 cohort in Bangkok underwent standardized neurologic examinations at Weeks 0 (AHI), 12, 96, and 288 following antiretroviral therapy (ART). A subset of participants completed 3T neuroimaging. Associations between neuroimaging, clinical and HIV parameters, and abnormal neurologic exam were analyzed using chi-square tests and multinomial regression. RESULTS: At AHI, 703 participants (median age 26.5 years, 97.6% male) had neurologic exams, with follow-up data available for 493, 667, and 560 participants at Weeks 12, 96, and 288, respectively. Viral suppression (≤ 50 copies/mL) was 0% at Week 0, 65% at Week 12, 98% at Week 96, and 99% at Week 288. Abnormalities in any neurologic exam domain were observed in 26%, 28%, 17%, and 8% of participants at each time point. Most findings occurred in sensory and fine motor domains. During AHI, history of HCV co-infection associated with abnormal exam (p = 0.006). At Weeks 96 and 288, higher CD4:CD8 ratio correlated with abnormal exam at the same visit (p = 0.040 Week 96, p = 0.018 Week 288). In a longitudinal model, higher Fiebig stage associated with conversion from abnormal to normal neurologic exam (p < 0.035). Of participants with MRIs, 14% at Week 0 and 36% at Week 96 demonstrated abnormalities; abnormal MRI at Week 0 associated with abnormal fine motor performance (p = 0.045). CONCLUSIONS: Objective neurologic abnormalities are common during AHI, though few persist with long-term ART. Coinfections, immunologic state, and demographic factors modify these outcomes.