Relationship between psychiatric disease and neuropsychological impairment in HIV seropositive individuals

Prevalence and Predictors of Substance Use Disorders Among HIV Care Enrollees in the United States

Prior efforts to estimate U.S. prevalence of substance use disorders (SUDs) in HIV care have been undermined by caveats common to single-site trials. The current work reports on a cohort of 10,652 HIV-positive adults linked to care at seven sites, with available patient data including geography, demography, and risk factor indices, and with substance-specific SUDs identified via self-report instruments with validated diagnostic thresholds. Generalized estimating equations also tested patient indices as SUD predictors. Findings were: (1) a 48 % SUD prevalence rate (between-site range of 21-71 %), with 20 % of the sample evidencing polysubstance use disorder; (2) substance-specific SUD rates of 31 % for marijuana, 19 % alcohol, 13 % methamphetamine, 11 % cocaine, and 4 % opiate; and (3) emergence of younger age and male gender as robust SUD predictors. Findings suggest high rates at which SUDs occur among patients at these urban HIV care sites, detail substance-specific SUD rates, and identify at-risk patient subgroups.

Major depressive disorder, cognitive symptoms, and neuropsychological performance among ethnically diverse HIV+ men and women

Major depressive disorder (MDD), cognitive symptoms, and mild cognitive deficits commonly occur in HIV-infected individuals, despite highly active antiretroviral therapies. In this study, we compared neuropsychological performance and cognitive symptoms of 191 HIV-infected participants. Results indicated that participants with a formal diagnosis of current MDD performed significantly worse than participants without MDD in all seven neuropsychological domains evaluated, with the largest effect sizes in information processing speed, learning, and memory. In addition, a brief assessment of cognitive symptoms, derived from a comprehensive neuromedical interview, correlated significantly with neurocognitive functioning. Participants with MDD reported more cognitive symptoms and showed greater neurocognitive deficits than participants without MDD. These findings indicate that HIV-infected adults with MDD have more cognitive symptoms and worse neuropsychological performance than HIV-infected individuals without MDD. The results of this study have important implications for the diagnosis of HIV-associated neurocognitive disorders (HAND).

The Impact of Depressive Symptoms on Neuropsychological Performance Tests in HIV-Infected Individuals: A Study of the Hawaii Aging with HIV Cohort

BACKGROUND: The frequency of neurocognitive impairment (NCI) in human immunodeficiency virus (HIV)-infected individuals remains high despite the availability of potent antiretroviral therapy (ART). The concurrence of depression among HIV-infected patients with NCI is common, especially among older individuals. Depression has been implicated as a risk factor for impaired neuropsychological performance (NP). This study explored the relationship between depressive symptoms and NP testing in HIV-infected individuals. METHODS: A cross-sectional analysis was performed within the Hawaii Aging with HIV Cohort, a large prospective study of cognition of older (50 or more years old) compared to younger (20 to 39 years old) HIV-infected individuals. RESULTS: Two hundred and eighty-five HIV infected participants (157 older and 128 younger) were administered a battery of NP tests to measure performance in major cognitive domains. Depressive symptoms were measured using the Beck Depression Inventory (BDI). The rates of depressive symptoms and neuropsychological impairment were similar in older and younger groups. Multivariate analyses revealed depressive symptoms were associated with NP test impairment in the younger group. In the older group, depressive symptoms were not associated with NP. CONCLUSION: This study suggests that depressive symptoms are associated with NP test impairment in younger HIV-infected individuals, but not in older individuals.

Neuropsychological impairment and gender differences in HIV-1 infection

AIMS

Research into neuropsychological consequences of HIV has focused mainly on male subjects, and therefore very little is known about the disease in female subjects and, of course, about gender differences. The aim of the present research was therefore to investigate neuropsychological impairment rates and pattern in HIV male and female patients, with regard to the study of gender differences in tasks assessing attention, memory for texts, digits and words, psychomotor speed, verbal intelligence and abstract reasoning.

METHODS

A clinical sample was recruited consisting of 122 subjects, divided into four groups: (i) 57 HIV+ men; (ii) 31 HIV+ women; (iii) 18 HIV- men and (iv) 16 HIV- women. All the subjects had more than 18 years, being the average of age of 34.08 for men and 33.35 for women. The evaluation of each subject consisted of a semistructured interview investigating sociodemographic, clinical and toxicological aspects and a neuropsychological assessment, with a battery of tests specifically selected for this study and chosen for their validity and because they have been shown to be sensitive to neuropsychological impairment in HIV-infected patients in other studies.

RESULTS

None of HIV- male and female groups fulfilled impairment criteria. Regarding the HIV+ group, a rate of neuropsychological impairment of 51.9% was obtained for the men and 54.8% for the women, but there were no significant differences between groups. Nevertheless, were detected significant differences in neuropsychological impairment rates between HIV+ and HIV- women, and also between HIV+ and HIV- men. Although HIV+ women presented multiple factors that could increase their neuropsychological vulnerability to the effects of HIV, HIV+ men had the same probability of having neuropsychological impairment as HIV+ women.

CONCLUSIONS

A different neuropsychological impairment pattern was detected between genders: while HIV+ men had greater impairment in visual memory, attention, psychomotor speed and abstract reasoning, HIV+ women had greater impairment on attention, psychomotor speed and verbal memory for texts.

Components of depression in HIV-1 infection: their differential relationship to neurocognitive performance

Both depression and neurocognitive compromise are commonly observed among persons infected with the Human Immunodeficiency Virus (HIV). To date, the majority of studies have failed to find a consistent relationship between mood and cognition among HIV-seropositive (HIV+) individuals, suggesting that these constructs are independent of one another. However, depression is a multi-dimensional syndrome and its measurement often utilizes multi-factorial instruments containing cognitive, affective, somatic, and motivational components. The degree to which various symptoms or dimensions of depression might be related to neuropsychological performance in HIV-1 infection is not typically explored and was a main objective of the current study. A sample of 247 HIV+ persons completed both a comprehensive neurocognitive battery and the Beck Depression Inventory (BDI) as part of a standard clinical evaluation at a major community hospital. To examine the dimensionality of the BDI, a principal components analysis was conducted which suggested a three-factor solution comprised of factors representing Self-Reproach (SR), Mood-Motivation Disturbance (MM), and Somatic Disturbance (SOM). The relationship between each of these three factors and neurocognitive performance was examined using both regression and analysis of variance techniques. These analyses showed the MM factor, more so than either the SR or SOM factors, to be associated with several aspects of neurocognitive performance, including verbal memory, executive functioning, and motor speed. These findings suggest that certain items on depression rating scales may be more indicative of central nervous system (CNS) involvement than others. The association between disturbance in mood and motivation and neurocognitive compromise may suggest that each are sequelae of disease specific mechanisms.

Influence of depressed mood on neuropsychologic performance in HIV-seropositive drug users

Some studies point out that depression affects the performance of HIV patients in neuropsychological tasks, but at present this effect is not clear. The purpose of the present paper was to study whether the presence of symptoms of depression affects the neuropsychologic performance of seropositive drug users in tasks of attention/concentration, learning and memory, language, construction and visuospatial function, speed of motor performance, cognitive flexibility, manual skill and concept formation and reasoning. In order to carry out this research a sample consisting of 127 male volunteer subjects was used. These subjects were distributed in four groups: one group consisted of HIV-seropositive drug users with symptoms of depression (n = 33); the second group consisted of HIV-seropositive drug users without symptoms of depression (n = 47); the third group was formed by HIV-seronegative drug users with symptoms of depression (n = 15) and the fourth group was formed by HIV-seronegative drug users without symptoms of depression (n = 32). The results reveal the effect of symptoms of depression (evaluated by the Beck Depression Inventory) on the neuropsychologic performance of seropositive drug users. This effect, however, was not observed in the seronegative group. These findings lead us to suggest that symptoms of depression constitute a risk factor for presenting neuropsychologic disturbances in seropositive subjects, which could well be acting as a factor that foments the neuropsychological effects of HIV.

Neuropsychiatric aspects of HIV infection among older adults

Treatment advances such as the advent of highly active antiretroviral therapy (HAART) have translated into greater life expectancy for HIV-infected individuals, which will ultimately result in a "graying" of the HIV/AIDS epidemic. In addition, older individuals are engaging in a higher rate of high risk behaviors than had been previously expected. As such, study of older HIV-infected patients, including study of the psychiatric and neurocognitive aspects of the disease, appears highly indicated. Epidemiological studies have demonstrated that HIV infection is associated with higher rates of several psychological/psychiatric disorders when compared to general population base rates. There is also a rich literature that has documented the adverse neurocognitive effects of HIV infection, ranging from subtle cognitive complaints to frank dementia, among younger adults. Although it has been hypothesized that older age may potentiate the deleterious effects of HIV infection, little is actually known, however, regarding the incidence, prevalence, course, and clinical features of HIV-associated psychiatric and cognitive dysfunction among older adults. This article provides an overview of the epidemiology and clinical manifestations of HIV-associated cognitive and psychiatric disorder across the age spectrum, with particular focus on what is known regarding the interaction of advancing age and HIV infection. Future directions for research are suggested, including basic epidemiologic study of incidence and prevalence rates of neurodisease among older HIV-infected adults as well as investigations designed to determine whether the nature, severity, course, or treatment of such disorders differs among older versus younger patients.

A short, psychiatric, case-finding measure for HIV seropositive outpatients: performance characteristics of the 5-item mental health subscale of the SF-20 in a male, seropositive sample

OBJECTIVES

The author assesses performance characteristics of the 5-item mental health scale (MHI-5) of the Medical Outcomes Study Short Form Health Survey when used as a psychiatric case-finding measure for human immunodeficiency virus (HIV) seropositive outpatients.

METHODS

Ninety-five HIV seropositive outpatients from two primary care practices were recruited and cross-sectionally studied. All subjects completed the MHI-5. Standardized Clinical Interview for DSM-III-R (SCID-NP-HIV) was used as the gold standard in assessing Axis I psychiatric disorders in the previous 6 months.

RESULTS

Thirty-three of 95 (35%) subjects had Axis I disorders (Axis I): 18 of 33 (55%) had a diagnosis of major depression (MD); 15 of 33 (45%) had another diagnosis (AD). Areas under receiver operator characteristic (ROC) curves were 0.76 (95% confidence interval [CI], 0.65, 0.87; Axis I), 0.84 (95% CI, 0.74, 0.94; MD), and 0.55 (95% CI, 0.38, 0.72; AD). The area under the MD curve was significantly greater than that for the AD curve (P = 0.0017). The optimal subscale score cut-off point on the MD curve was 52. Test characteristics for this cut-off point were: sensitivity, 83%; specificity, 65%; positive predictive value, 36%; negative predictive value, 94%; likelihood ratio for a positive test, 2.37; and likelihood ratio for a negative test, 0.26.

CONCLUSIONS

The MHI-5 is the first short psychiatric case-finding measure for which performance characteristics have been reported for HIV seropositive outpatients. Test characteristics suggest that it may be a useful case-finding measure for these patients. A positive finding may indicate a diagnosis of recent major depression.

Human immunodeficiency virus (HIV) infection and quality of life: the potential impact of Axis I psychiatric disorders in a sample of 95 HIV seropositive men

OBJECTIVE

The purpose of this study is to assess whether Axis I psychiatric disorders exert effects on function and well-being independent of human immunodeficiency virus (HIV)-related disease progression.

METHODS

A convenience sample of 95 HIV seropositive individuals completed the Medical Outcomes Study Short Form Health Survey (SF-20). The Standardized Clinical Interview for DSM-III-R (SCID-NP-HIV) was used to screen subjects for Axis I psychiatric disorders in the previous 6 months. HIV-related disease severity was defined for each subject using the 1993 revised Centers for Disease Control (CDC) Classification System.

RESULTS

Thirty-seven (39%) subjects had asymptomatic HIV disease and 58 (61%) had symptomatic disease. Thirty-three (35%) subjects had Axis I disorders in the previous 6 months. After controlling for HIV-related disease severity, psychiatric disorders were independently associated with substantive decrements in the mental health and health perceptions dimension scores (beta-coefficients were approximately -18.0 for both dimensions; p < or = 0.01). Axis I disorders were also associated with decrements in the social functioning dimension at a p value that approached significance (p = 0.04).

CONCLUSIONS

In HIV seropositive individuals, the presence of an Axis I psychiatric disorder in the previous 6 months is associated with diminished scores in multiple areas of functioning and well-being, independent of HIV-related disease progression. Axis I disorders, therefore, appear to impact quality of life. These findings, in part, suggest that the SF-20 (the mental health subscale, in particular) may have utility as a screening tool for the presence of a recent Axis I diagnosis.