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Ridgely NC, Woods SP, Webber TA, Mustafa AI, Evans D. Cognitive Intra-individual Variability in the Laboratory Is Associated With Greater Executive Dysfunction in the Daily Lives of Older Adults With HIV. Cogn Behav Neurol 2024; 37:32-39. [PMID: 37871277 PMCID: PMC10948322 DOI: 10.1097/wnn.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/30/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Executive dysfunction, which is common among persons with HIV (PWH), can have an adverse impact on health behaviors and quality of life. Intra-individual variability (IIV) is a measure of within-person variability across cognitive tests that is higher in PWH and is thought to reflect cognitive dyscontrol. OBJECTIVE To assess whether cognitive IIV in the laboratory is associated with self-reported executive dysfunction in daily life among older PWH. METHOD Participants included 71 PWH aged ≥50 years who completed six subtests from the Cogstate battery and two subscales from the Frontal Systems Behavior Scale (FrSBe; self-report version). Cognitive IIV was calculated from the Cogstate as the coefficient of variation derived from age-adjusted normative T scores. RESULTS Cognitive IIV as measured by the Cogstate showed a significant, positive, medium-sized association with current FrSBe ratings of executive dysfunction but not disinhibition. CONCLUSION Higher cognitive IIV in the laboratory as measured by the Cogstate may be related to the expression of HIV-associated symptoms of executive dysfunction in daily life for older PWH.
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Zhan Y, Cai DC, Liu Y, Song F, Shan F, Song P, Chen G, Zhang Y, Wang H, Shi Y. Altered metabolism in right basal ganglia associated with asymptomatic neurocognitive impairment in HIV-infected individuals. Heliyon 2024; 10:e23342. [PMID: 38169709 PMCID: PMC10758793 DOI: 10.1016/j.heliyon.2023.e23342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 06/02/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Background Only few studies have focused on the metabolite differences between asymptomatic neurocognitive impairment (ANI) and cognitively normal people living with HIV (PLWH). The current study aims to examine whether brain metabolisms in basal ganglia (BG) by magnetic resonance spectroscopy (MRS) were potential to discriminate ANI from cognitively normal PLWH. Methods According to neuropsychological (NP) test, 80 PLWH (37.4 ± 10.2 years) were divided into ANI group (HIV-ANI, n = 31) and NP normal group (HIV-normal, n = 49). Brain metabolisms by MRS from right BG were compared between groups, including N-acetylaspartate and N-acetyl aspartylglutamate (tNAA), creatine and phosphocreatine (tCr), and choline-containing compounds (tCho). A total value of three metabolites were introduced. All brain metabolisms were evaluated as its percentage of total. Furthermore, correlations between MRS and NP and clinical measures were evaluated. A logistic regression model was applied, and the AUC values for the model and the continuous factors were compared using receiver operating curve (ROC) analysis. Results Compared to HIV-normal group, tNAA/total was lower and tCr/total was higher in the HIV-ANI group (P < 0.05). Both tNAA/total and tCr/total values were correlated with NP score (P < 0.05), especially in verbal fluency, speed of information processing, learning, and recall (P < 0.05). The logistic model included BG-tCr/total, current CD4 and infection years of PLWH. The AUC value for the BG-tCr/total was 0.696 and was not significantly lower than that for logistic model (P < 0.01). Conclusion The altered brain metabolites in the right BG were found in the ANI group compared to PLWH with normal cognition, and further associated with NP deficits. The current findings indicated that brain metabolites assessed by MRS has the potential to discriminate ANI from cognitively normal PLWH.
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Affiliation(s)
- Yi Zhan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Dan-Chao Cai
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ying Liu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Fengxiang Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Pengrui Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Guochao Chen
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yijun Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Alcocer-Bruno C, Ferrer-Cascales R, Ruiz-Robledillo N, Clement-Carbonell V. The mediation effect of treatment fatigue in the association between memory and health-related quality of life in men with HIV who have sex with men. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 38145625 DOI: 10.1080/23279095.2023.2298375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Approximately half of all adults living with the Human Immunodeficiency Virus (HIV) experience cognitive alterations related to difficulties in treatment adherence and, therefore, to a significant decrease in quality of life. In this sense, new studies are needed to identify potential mediators related to treatment in this association, such as treatment fatigue. This fact is especially important in at specific groups of individuals with HIV, namely men with HIV who have sex with men (MSM). The objective of this study was to analyze the association between cognitive functioning, Health-Related Quality of Life (HRQoL), and treatment fatigue in MSM with HIV. A cross-sectional study was developed with a sample of 70 MSM, from the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). Participants completed questionnaires related to sociodemographic data, HRQoL, and treatment fatigue in an initial phase; in a second phase, they were administered a computerized cognitive evaluation. Our results demonstrate a significant relationship between a lower cognitive performance in the memory domain and worse HRQoL. Mediation analysis has revealed the total mediation effect of treatment fatigue, specifically, the treatment cynicism domain, on this relationship. This mediation effect remained significant after controlling the sociodemographic and clinical HIV-related variables in the model. No significant mediation effects of the rest of evaluated cognitive domains (attention, perception, reasoning, or coordination) were found in this relationship. The results of this study highlight how MSM with a significant deterioration of memory are at greater risk of developing high levels of treatment fatigue, and, therefore, a lower adherence to the same and a significant deterioration in their HRQoL.
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Affiliation(s)
- C Alcocer-Bruno
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - R Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - N Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - V Clement-Carbonell
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
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Moore RC, Kuehn KS, Heaton A, Sundermann EE, Campbell LM, Torre P, Umlauf A, Moore DJ, Kosoris N, Wright DW, LaPlaca MC, Waldrop D, Anderson AM. An Automated Virtual Reality Program Accurately Diagnoses HIV-Associated Neurocognitive Disorders in Older People With HIV. Open Forum Infect Dis 2023; 10:ofad592. [PMID: 38149107 PMCID: PMC10750141 DOI: 10.1093/ofid/ofad592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
Background HIV-associated neurocognitive disorders (HANDs) remain prevalent despite antiretroviral therapy, particularly among older people with HIV (PWH). However, the diagnosis of HAND is labor intensive and requires expertise to administer neuropsychological tests. Our prior pilot work established the feasibility and accuracy of a computerized self-administered virtual reality program (DETECT; Display Enhanced Testing for Cognitive Impairment and Traumatic Brain Injury) to measure cognition in younger PWH. The present study expands this to a larger sample of older PWH. Methods We enrolled PWH who were ≥60 years old, were undergoing antiretroviral therapy, had undetectable plasma viral loads, and were without significant neuropsychological confounds. HAND status was determined via Frascati criteria. Regression models that controlled for demographic differences (age, sex, education, race/ethnicity) examined the association between DETECT's cognition module and both HAND status and Global Deficit Score (GDS) derived via traditional neuropsychological tests. Results Seventy-nine PWH (mean age, 66 years; 28% women) completed a comprehensive neuropsychological battery and DETECT's cognition module. Twenty-five (32%) had HAND based on the comprehensive battery. A significant correlation was found between the DETECT cognition module and the neuropsychological battery (r = 0.45, P < .001). Furthermore, in two separate regression models, HAND status (b = -0.79, P < .001) and GDS impairment status (b = -0.83, P < .001) significantly predicted DETECT performance. Areas under the curve for DETECT were 0.78 for differentiating participants by HAND status (HAND vs no HAND) and 0.85 for detecting GDS impairment. Conclusions The DETECT cognition module provides a novel means to identify cognitive impairment in older PWH. As DETECT is fully immersive and self-administered, this virtual reality tool holds promise as a scalable cognitive screening battery.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Kevin S Kuehn
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Anne Heaton
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Erin E Sundermann
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Laura M Campbell
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
- University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, California, USA
| | - Peter Torre
- San Diego State University, San Diego, California, USA
| | - Anya Umlauf
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | | | - David W Wright
- Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Michelle C LaPlaca
- Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, Georgia, USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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Garvie PA, Loop MS, Zhou CW, McCumber M, Woods SP, Nichols SL. Neuropsychological Correlates of Adherence in Youth with Behaviorally Acquired HIV. AIDS Behav 2023; 27:3813-3829. [PMID: 37351688 DOI: 10.1007/s10461-023-04096-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/24/2023]
Abstract
Youth living with behaviorally acquired HIV (YLWH) are at-risk for both neuropsychological disorders and antiretroviral therapy (ART) non-adherence; little is known about their interrelationship over time in YLWH. Neuropsychological and psychiatric functioning, substance use, and self-report of 7-day/week and weekend ART adherence were assessed at baseline and Weeks 24, 48, 96 and 144 of a longitudinal study evaluating the impact of early (CD4>350) versus standard of care (CD4≤350) treatment initiation on neuropsychological functioning in 111 treatment-naïve YLWH age 18-24 years at entry. Bayesian multi-level models for adherence (≥ 90% vs. <90%) were fit using random intercepts for repeated measures. Adjusted odds ratios (OR [95% credible interval]) for higher versus lower baseline Motor function for visit adherence were 0.58 (0.25, 1.16), 0.5 (0.15, 1.38), 0.52 (0.16, 1.52), and 0.94 (0.3, 2.8) at Weeks 24, 48, 96, and 144, respectively. Week 24 adherence was associated with higher adjusted odds of Motor function at Week 48 (week: 0.27, -0.05-0.59; weekend: 0.28, -0.07-0.62). Week 96 Complex Executive functioning was associated with higher adjusted odds of adherence at Week 144, OR = 4.26 (1.50, 14.33). Higher Motor functioning emerged most consistently associated with lower odds of adherence in YLWH. Complex Executive functioning was associated with adherence only at end of study, suggesting potential contribution in adherence over the long-term.
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Affiliation(s)
- Patricia A Garvie
- Research Department, Children's Diagnostic & Treatment Center, Fort Lauderdale, FL, USA.
| | - Matthew S Loop
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christina W Zhou
- Department of Biostatistics, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Micah McCumber
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Sharon L Nichols
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
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Dreyer AJ, Nightingale S, Andersen LS, Lee JS, Gouse H, Safren SA, O’Cleirigh C, Thomas KGF, Joska J. Cognitive Performance, as well as Depression, Alcohol Use, and Gender, predict Anti-Retroviral Therapy Adherence in a South African Cohort of People with HIV and Comorbid Major Depressive Disorder. AIDS Behav 2023; 27:2681-2694. [PMID: 36708417 PMCID: PMC10338393 DOI: 10.1007/s10461-023-03992-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
Depression and cognitive impairment, which commonly coexist in people with HIV (PWH), have been identified as potential barriers to optimal antiretroviral therapy (ART) adherence. We investigated associations between cognitive performance, depression (as well as other sociodemographic, psychosocial and psychiatric variables) and ART adherence in a South African cohort of PWH with comorbid major depressive disorder (MDD). Cognitive performance and ART adherence were assessed at two time points 8 months apart (Nbaseline = 105, Nfollow-up = 81). Adherence was indicated by self-report, objective measures (Wisepill usage and plasma tenofovir-diphosphate levels), and HIV viral suppression. Mixed-effects regression models examined associations across both time points. Univariate models detected no significant associations between cognitive performance (globally and within-domain) and ART adherence. Multivariate modelling showed increased depression severity (β = - 0.54, p < 0.001) and problematic alcohol use (β = 0.73, p = 0.015) were associated with worse adherence as measured subjectively. Being female (OR 0.27, p = 0.048) and having better global cognitive performance (OR 1.83, p = 0.043) were associated with better adherence as indicated by viral suppression. This study identifies poor global cognitive performance, as well as depression and problematic alcohol use, as potential barriers to optimal ART adherence in PWH and comorbid MDD. Hence, clinicians could consider assessing for cognitive deficits, depression, and problematic alcohol use, and should endeavour to provide the appropriate support so as to improve adherence.
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Affiliation(s)
- Anna J. Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jasper S. Lee
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Hetta Gouse
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | | | - Conall O’Cleirigh
- Department of Psychology, Harvard Medical School, Boston, MA USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Kevin G. F. Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Mesías-Gazmuri J, Folch C, Palacio-Vieira J, Bruguera A, Egea-Cortés L, Forero CG, Hernández J, Miró JM, Navarro J, Riera M, Peraire J, Alonso-García L, Díaz Y, Casabona J, Reyes-Urueña J. Syndemic conditions and quality of life in the PISCIS Cohort of people living with HIV in Catalonia and the Balearic Islands: a cross sectional study. Health Qual Life Outcomes 2023; 21:42. [PMID: 37165368 PMCID: PMC10173626 DOI: 10.1186/s12955-023-02120-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/24/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND People living with HIV (PLWH) face structural and psychosocial factors that affect health-related quality of life (HRQoL). We aimed to evaluate how syndemic conditions affected HRQoL in PLWH. METHODS A cross-sectional survey was conducted among 861 PLWH, to determine whether syndemic conditions (monthly income; sexual satisfaction; depressive symptoms; social role satisfaction; social isolation; cognitive function; nicotine dependence; perception of stigma) have an effect on HRQoL. A linear regression model and measures of Additive Interaction (AI) were used to determine the effects of syndemic conditions on HRQoL, controlling for other risk factors. RESULTS Overall, the most frequently observed were stigma perception (56.9%), poor cognitive function (50.6%) and the perception of social isolation (51.6%). The presence of depressive symptoms was the risk factor most associated with worse Physical Health (PH) (B 3.93, 2.71-5.15) and Mental Health (MH) (B 5.08, 3.81-6.34) in linear regression model. Specifically, an interaction was observed between poor cognitive function and poor satisfaction with social role on worse PH and MH (AI 2.08, 0.14-4.02; AI 2.69, 0.15-5.22, respectively); and low income and perception of stigma (AI 2.98, 0.26-5.71), low income and perception of social isolation (AI 2.79, 0.27-5.32), and low income and poor satisfaction with social role (AI 3.45, 0.99-5.91) on MH. CONCLUSION These findings provide evidence that syndemic factors impact HRQoL. HIV prevention programs should screen and address co-occurring health problems to improve patient-centered health care and outcomes.
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Affiliation(s)
- Jocelyn Mesías-Gazmuri
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- PhD in Methodology of Biomedical Research and Public Health, Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universidad Autonoma de Barcelona, Badalona, Spain
| | - Cinta Folch
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain.
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain.
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain.
| | - Jorge Palacio-Vieira
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Andreu Bruguera
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- PhD in Methodology of Biomedical Research and Public Health, Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universidad Autonoma de Barcelona, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Laia Egea-Cortés
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Carlos G Forero
- Department of Medicine. School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain
| | - Juan Hernández
- Grupo de Trabajo Sobre Tratamientos del VIH (gTt), Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service. Hospital Clínic-IDIBAPS. University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Navarro
- Infectious Diseases Department. Hospital, Universitari Vall d'Hebron, Barcelona, Spain
- Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | | | - Joaquim Peraire
- Infectious Diseases Department. Hospital, Universitari Vall d'Hebron, Barcelona, Spain
- Hospital Joan XXIII, IISPV, Universitat Rovira I Virgili, Tarragona, Spain
| | - Lucía Alonso-García
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Yesika Díaz
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Univ Autonoma de Barcelona, Badalona, Spain
| | - Juliana Reyes-Urueña
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
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Dreyer AJ, Nightingale S, Andersen LS, Lee JS, Gouse H, Safren SA, O’Cleirigh C, Thomas KGF, Joska JA. Sex Differences in the Cognitive Performance of a South African Cohort of People With HIV and Comorbid Major Depressive Disorder. J Int Assoc Provid AIDS Care 2023; 22:23259582231203192. [PMID: 37787183 PMCID: PMC10548808 DOI: 10.1177/23259582231203192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023] Open
Abstract
Women with HIV (WWH) may be more vulnerable to cognitive impairment than men with HIV (MWH), which may be explained by the direct effects of HIV or by sociodemographic and psychiatric characteristics. We recruited 105 people with HIV (PWH; 76 women) with incomplete antiretroviral therapy adherence, comorbid major depressive disorder, and socioeconomically disadvantaged backgrounds. Participants completed neuropsychological testing and measures gathering sociodemographic, medical, and psychiatric information. We compared WWH and MWH cognitive performance using unadjusted and adjusted regressions, and within each respective group, we explored predictors of cognitive performance. Results showed no significant between-sex differences in cognitive performance, both globally and within domains. Fewer years of education (β = 0.94), illiteracy (β = 4.55), and greater food insecurity (β = -0.28) predicted lower cognitive performance in WWH but not MWH. We conclude that sex differences in PWH are likely due to sample characteristics representing broader inequalities, rather than true biological differences.
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Affiliation(s)
- Anna J. Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
| | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
| | - Jasper S. Lee
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Hetta Gouse
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, , Coral Gables, FL, USA
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - Kevin G. F. Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
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9
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Robbins RN, Santoro AF, Ferraris C, Asiedu N, Liu J, Dolezal C, Malee KM, Mellins CA, Paul R, Thongpibul K, Puthanakit T, Aurpibul L. Adaptation and construct validity evaluation of a tablet-based, short neuropsychological test battery for use with adolescents and young adults living with HIV in Thailand. Neuropsychology 2022; 36:695-708. [PMID: 35980694 PMCID: PMC9897317 DOI: 10.1037/neu0000851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Deficits in neurocognitive functioning are common among adolescents and young adults (AYA) with perinatally acquired HIV (PHIV). Limitations of traditional neuropsychological tests hinder assessment of neurocognition in low- and middle-income countries where most AYA with PHIV reside. Computerized testing could make assessment of neurocognition more accessible in these countries. This study examined a culturally modified NeuroScreen, a tablet-based neurocognitive testing app, for use in Thailand. Construct validity was examined among Thai AYA (13-23 years) with and without PHIV. METHOD NeuroScreen underwent adaptation including language, content, and usability review by Thai psychologists, AYA, and clinical staff. One hundred Thai AYA (50 PHIV; 50 HIV-uninfected, matched controls) were administered the adapted NeuroScreen and a battery of traditional paper-and-pencil neuropsychological tests. Correlations, mean differences, and proportions with impaired performance were examined across NeuroScreen and the traditional tests. RESULTS The Thai version of NeuroScreen was deemed understandable and culturally appropriate. A large correlation (.82) between overall performance on the NeuroScreen and traditional batteries was observed. Small-to-large correlations were found between conceptually similar NeuroScreen and traditional tests of processing speed, working memory, motor speed, and executive functioning. Mean test performance differences between AYA with PHIV and controls were similar between test batteries. Both sets of tests identified similar rates of impaired participants. CONCLUSIONS Results provide support for the acceptability and construct validity of the Thai NeuroScreen tests to assess neurocognition in Thai AYA with PHIV. An easy-to-use tool to assess neurocognition can help Thai providers provide better care for AYA with PHIV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Nana Asiedu
- HIV Center for Clinical and Behavioral Studies
| | - Jun Liu
- New York State Psychiatric Institute
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JAKEMAN B, SCHERRER AU, DARLING KEA, DAMAS J, BIELER-AESCHLIMANN M, HASSE B, SCHLOSSER L, HACHFELD A, GUTBROD K, TARR PE, CALMY A, ASSAL F, KUNZE U, STOECKLE M, SCHMID P, TOLLER G, ROSSI S, DI BENEDETTO C, DU PASQUIER R, CAVASSINI M, MARZOLINI C. Anticholinergic and sedative medications are associated with neurocognitive performance of well-treated people living with HIV. Open Forum Infect Dis 2022; 9:ofac457. [PMID: 36147598 PMCID: PMC9487636 DOI: 10.1093/ofid/ofac457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background We previously showed that anticholinergic (ACH) medications contribute to self-reported neurocognitive impairment (NCI) in elderly people with human immunodeficiency virus (PWH). The current cross-sectional study further evaluated the effect of ACH and sedative drugs on neurocognitive function in PWH who underwent comprehensive neuropsychological evaluation. Methods A medication review was performed in PWH enrolled in the prospective Neurocognitive Assessment in Metabolic and Aging Cohort within the Swiss HIV Cohort Study. Neurocognitive functions were analyzed in 5 domains (motor skills, speed of information, attention/working memory, executive functions, and verbal learning memory). The effect of ACH and sedative medications on neurocognitive functioning was evaluated using linear regression models for the continuous (mean z-score) outcome and multivariable logistic regression models for the binary (presence/absence) outcome. Results A total of 963 PWH (80% male, 92% Caucasian, 96% virologically suppressed, median age 52) were included. Fourteen percent of participants were prescribed ≥1 ACH medication and 9% were prescribed ≥1 sedative medication. Overall, 40% of participants had NCI. Sedative medication use was associated with impaired attention/verbal learning and ACH medication use with motor skills deficits both in the continuous (mean z-score difference −0.26 to −0.14, P < .001 and P = .06) and binary (odds ratio [OR], ≥1.67; P < .05) models. Their combined use was associated with deficits in overall neurocognitive functions in both models (mean z-score difference −0.12, P = .002 and OR = 1.54, P = .03). These associations were unchanged in a subgroup analysis of participants without depression (n = 824). Conclusions Anticholinergic and sedative medications contribute to NCI. Clinicians need to consider these drugs when assessing NCI in PWH.
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Affiliation(s)
- Bernadette JAKEMAN
- Department of Pharmaceutical Practice and Administrative Sciences, University of New Mexico College of Pharmacy , Albuquerque , USA
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, University of Basel , Switzerland
| | - Alexandra U SCHERRER
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich , Switzerland
- Institute of Medical Virology, University of Zurich , Switzerland
| | - Katharine E A DARLING
- Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne , Switzerland
| | - Jose DAMAS
- Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne , Switzerland
| | - Melanie BIELER-AESCHLIMANN
- Service of Neurology, Department of Neurosciences, University Hospital Lausanne, University of Lausanne , Switzerland
| | - Barbara HASSE
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich , Switzerland
| | - Ladina SCHLOSSER
- Department of Neuropsychology, Neurology Clinic, University Hospital Zurich , Switzerland
| | - Anna HACHFELD
- Department of Infectious Diseases, University Hospital Bern, University of Bern , Switzerland
| | - Klemens GUTBROD
- Department of Neurology, University Hospital Bern, University of Bern, Switzerland and Neurozentrum , Bern , Switzerland
| | - Philip E TARR
- University Department of Medicine, Kantonsspital Bruderholz, University of Basel , Switzerland
| | - Alexandra CALMY
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva , Switzerland
| | - Frederic ASSAL
- Service of Neurology, University Hospital Geneva, University of Geneva , Switzerland
| | - Ursula KUNZE
- Memory Clinic, Felix Platter Hospital University Center for Medicine of Aging , Basel , Switzerland
| | - Marcel STOECKLE
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, University of Basel , Switzerland
| | - Patrick SCHMID
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen , Switzerland
| | - Gianina TOLLER
- Neuropsychology Unit, Department of Neurology, Cantonal Hospital St Gallen , Switzerland
| | - Stefania ROSSI
- Neuropsychology and Speech Therapy Unit, Neurocenter of Southern Switzerland, Regional Hospital Lugano , Switzerland
| | | | - Renaud DU PASQUIER
- Service of Neurology, Department of Neurosciences, University Hospital Lausanne, University of Lausanne , Switzerland
| | - Matthias CAVASSINI
- Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne , Switzerland
| | - Catia MARZOLINI
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, University of Basel , Switzerland
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11
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Beltran-Najera I, Thompson JL, Matchanova A, Sullivan KL, Babicz MA, Woods SP. Neurocognitive performance differences between black and white individuals with HIV disease are mediated by health literacy. Clin Neuropsychol 2022; 36:414-430. [PMID: 34311657 PMCID: PMC8789952 DOI: 10.1080/13854046.2021.1953147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective:Health disparities are evident for Black Americans with HIV disease, who are disproportionally affected by the epidemic in the United States. The current study investigated whether the higher rates of neurocognitive impairment in Black Americans with HIV disease may be at least partly attributable to health literacy, which is a potentially modifiable factor. Method: Participants were 61 White and 25 Black participants (ages 27-70) with HIV disease who were enrolled in studies at an urban academic center in Southern California. Neurocognitive function was assessed by an age-adjusted global score from the Cogstate battery. Health literacy was measured by a composite score derived from the Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign, and 3-Brief. Results: Bootstrap confidence interval mediation analyses showed that health literacy was a significant mediator of the relationship between race and neurocognition; that is, there were no direct ethnoracial differences in neurocognition after accounting for health literacy. A follow-up model to confirm the directionality of this association demonstrated that neurocognition was not a significant mediator of the relationship between race and health literacy. Conclusions: Low health literacy may contribute to the higher rates of neurocognitive impairment for Black Americans with HIV disease. Future studies might examine the possible mechanism of this mediating relationship (e.g., access to health information, health behaviors, socioeconomics) and determine whether culturally tailored interventions that improve health literacy also confer broader brain health benefits for Black Americans with HIV disease.
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Affiliation(s)
| | | | | | | | | | - Steven Paul Woods
- Correspondence may be addressed to Steven Paul Woods, Department of Psychology, 126 Heyne Bldg. (Ste. 239d), University of Houston, Houston, Texas, 77004; 713-743-6415;
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12
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Combined effects of older age and HIV disease on changes in everyday functioning over one year. J Neurovirol 2022; 28:133-144. [PMID: 34981439 DOI: 10.1007/s13365-021-01034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/05/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
Older age and HIV disease are independent risk factors for problems in many aspects of everyday functioning. However, less is known about how these risk factors may combine to influence everyday functioning over time. The current study examined the possible combined effects of age and HIV serostatus on change in everyday functioning over a 1-year period and its specific associations with changes in neurocognition. A repeated measures factorial design was employed. Participants included 77 older persons with HIV (PWH), 35 younger PWH, 44 older HIV-, and 27 younger HIV-adults who each completed baseline and follow-up visits approximately 14 months apart. Everyday functioning was assessed using a standardized self-report measure of activities of daily living (ADLs) at each visit. A comprehensive clinical battery assessed six domains of neurocognition. Raw scores on each neurocognitive measure were converted to sample-based z-scores, from which a global neurocognitive z-score was derived. Older PWH reported the poorest everyday functioning at baseline and follow-up visits at medium-to-large effect sizes. However, these ADL disruptions among older PWH were relatively stable over time, differing significantly from younger PWH who evidenced mild ADL improvements from baseline to follow-up. Within the entire sample, everyday functioning at baseline predicted neurocognitive performance at follow-up, but the reciprocal relationship was not significant. Older adults with HIV have high rates of ADL problems, which appear stable over 1 year, the trajectory of which differed from younger adults with HIV for whom mild improvements were observed. Importantly, the results also suggest that problems with ADLs may sometimes precede neurocognitive declines. Further examination of longitudinal data is needed to elucidate the long-term trajectory of neurocognitive and functional changes in older PWH to support early detection and proper management of clinical care.
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13
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Anderson AM, Ma Q, Letendre SL, Iudicello J. Soluble Biomarkers of Cognition and Depression in Adults with HIV Infection in the Combination Therapy Era. Curr HIV/AIDS Rep 2021; 18:558-568. [PMID: 34780037 PMCID: PMC8860504 DOI: 10.1007/s11904-021-00581-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Cognitive impairment and depression continue to be common among people with HIV (PWH) in the combination antiretroviral therapy (ART) era. A better understanding of the biological mechanisms that may underpin these disorders is needed. The purpose of this review is to describe published findings on soluble biomarkers from blood and cerebrospinal fluid (CSF) that have been associated with either cognition or depression among PWH in the setting of ART. RECENT FINDINGS Several biomarkers, including those that reflect viral persistence, monocyte/macrophage activation, and other processes, are associated with cognition and depressive symptoms. Some but not all results have been consistent across multiple studies. More research has been published on biomarkers of cognition relative to biomarkers of depression (particularly from CSF). More studies are needed that investigate multiple biomarkers to understand the role of distinct but additive pathways in these disorders and to guide the development of new therapies.
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Affiliation(s)
- Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 341 Ponce de Leon Avenue, Atlanta, GA, 30308, USA.
| | - Qing Ma
- University at Buffalo, Buffalo, NY, USA
| | - Scott L Letendre
- Departments of Medicine and Psychiatry, University of California at San Diego, San Diego, CA, USA
| | - Jennifer Iudicello
- Departments of Medicine and Psychiatry, University of California at San Diego, San Diego, CA, USA
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14
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Robbins RN, Scott TM, Gouse H, Marcotte TD, Rourke SB. Screening for HIV-Associated Neurocognitive Disorders: Sensitivity and Specificity. Curr Top Behav Neurosci 2021; 50:429-478. [PMID: 32677005 DOI: 10.1007/7854_2019_117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
HIV-associated neurocognitive disorder (HAND) remains prevalent among people living with HIV (PLWH), especially the mild forms, even those with well-controlled HIV. Recommendations from the literature suggest routine and regular screening for HAND to detect it early and manage it effectively and adjust treatments, if warranted, when present. However, screening for HAND is not routinely done, as there are no current guidelines on when to screen and which test or tests to use. Furthermore, many of the available screening tools for HAND often cannot accurately detect the mild forms of HAND and require highly trained healthcare professionals to administer and score the tests, a requirement that is not feasible for those low- and middle-income countries with the highest HIV incidence and prevalence rates. The purpose of this chapter was to review recent research on screening tests to detect HAND and report on the strengths, limitations, and psychometric properties of those tests to detect HAND.
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Affiliation(s)
- Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Medical Center, New York, NY, USA.
| | - Travis M Scott
- Department of Psychology, Fordham University, The Bronx, NY, USA.,VA Palo Alto Health Care System, Sierra Pacific MIRECC, Palo Alto, CA, USA
| | - Hetta Gouse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Thomas D Marcotte
- HIV Neurobehavioral Research Program, Center for Medicinal Cannabis Research, University of California, San Diego, San Diego, CA, USA
| | - Sean B Rourke
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto University, Toronto, ON, Canada
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15
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Niemczak CE, Lichtenstein JD, Magohe A, Amato JT, Fellows AM, Gui J, Huang M, Rieke CC, Massawe ER, Boivin MJ, Moshi N, Buckey JC. The Relationship Between Central Auditory Tests and Neurocognitive Domains in Adults Living With HIV. Front Neurosci 2021; 15:696513. [PMID: 34658754 PMCID: PMC8517794 DOI: 10.3389/fnins.2021.696513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/07/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: Tests requiring central auditory processing, such as speech perception-in-noise, are simple, time efficient, and correlate with cognitive processing. These tests may be useful for tracking brain function. Doing this effectively requires information on which tests correlate with overall cognitive function and specific cognitive domains. This study evaluated the relationship between selected central auditory focused tests and cognitive domains in a cohort of normal hearing adults living with HIV and HIV- controls. The long-term aim is determining the relationships between auditory processing and neurocognitive domains and applying this to analyzing cognitive function in HIV and other neurocognitive disorders longitudinally. Method: Subjects were recruited from an ongoing study in Dar es Salaam, Tanzania. Central auditory measures included the Gap Detection Test (Gap), Hearing in Noise Test (HINT), and Triple Digit Test (TDT). Cognitive measures included variables from the Test of Variables of Attention (TOVA), Cogstate neurocognitive battery, and Kiswahili Montreal Cognitive Assessment (MoCA). The measures represented three cognitive domains: processing speed, learning, and working memory. Bootstrap resampling was used to calculate the mean and standard deviation of the proportion of variance explained by the individual central auditory tests for each cognitive measure. The association of cognitive measures with central auditory variables taking HIV status and age into account was determined using regression models. Results: Hearing in Noise Tests and TDT were significantly associated with Cogstate learning and working memory tests. Gap was not significantly associated with any cognitive measure with age in the model. TDT explained the largest mean proportion of variance and had the strongest relationship to the MoCA and Cogstate tasks. With age in the model, HIV status did not affect the relationship between central auditory tests and cognitive measures. Age was strongly associated with multiple cognitive tests. Conclusion: Central auditory tests were associated with measures of learning and working memory. Compared to the other central auditory tests, TDT was most strongly related to cognitive function. These findings expand on the association between auditory processing and cognitive domains seen in other studies and support evaluating these tests for tracking brain health in HIV and other neurocognitive disorders.
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Affiliation(s)
- Christopher E. Niemczak
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jonathan D. Lichtenstein
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Albert Magohe
- Department of Otorhinolaryngology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jennifer T. Amato
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Abigail M. Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jiang Gui
- Department of Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Michael Huang
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Catherine C. Rieke
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Enica R. Massawe
- Department of Otorhinolaryngology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael J. Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Ndeserua Moshi
- Department of Otorhinolaryngology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jay C. Buckey
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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16
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Kidney transplantation and action-intentional improvements: Evidence from an ERP study. Int J Psychophysiol 2021; 170:51-58. [PMID: 34547304 DOI: 10.1016/j.ijpsycho.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/21/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
Reaction slowing observed in dialyzed patients results from deficits in initiating and sustaining motor response mobilization. The present study aimed at investigating whether these deficits are reversible following successful kidney transplantation. To achieve this goal, behavioral and electrophysiological (EEG) data were assessed from healthy control participants as well as kidney transplant and dialyzed patients performing a series of reaction time tasks. The results demonstrated that in patients who received kidney transplant a normalization of response latencies and brain preparatory activity was observed. At the same time, when compared to healthy individuals, increased attention engagement was observed in both clinical groups of patients. No behavioral and electrophysiological indices of impaired monitoring were observed in any of the clinical groups.
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17
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Ripamonti E, Clerici M. Living With Chronic HIV Disease in the Antiretroviral Era: The Impact of Neurocognitive Impairment on Everyday Life Functions. TOPICS IN ANTIVIRAL MEDICINE 2021; 29:386-396. [PMID: 34370420 PMCID: PMC8384087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
Although there is extensive literature around the biologic correlations of neurocognitive function in HIV/AIDS, less is known about the impact in everyday living. We conducted a systematic review of the association of neurocognitive impairment with everyday life functions in people with HIV on antiretroviral therapy. We specifically focused on attention, executive function, processing speed, and the central executive component of the working memory. We considered 3 domains of everyday functions: (1) autonomy, (2) decision making and adherence to treatment, and (3) quality of life and psychologic wellbeing. The relationship between neurocognitive impairment and mental health was examined, given its correlation with everyday life functions. Results indicate that people with HIV do experience problems with autonomy of daily living (especially if aged older than 50 years) and with decision making, and neurocognitive impairment plays a role in this regard. Psychologic wellbeing is associated with executive function and processing speed. These patients may also have a reduced quality of life, but the relationship between quality of life and cognition is uncertain or could be mediated by other factors. Neurocognitive impairment correlates with depression and anxiety; however, the relationship of cognitive performance with apathy is still controversial.
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Affiliation(s)
- Enrico Ripamonti
- Send correspondence to Enrico Ripamonti, Milan Center for Neuroscience NeuroMI, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy, or email
| | - Mario Clerici
- Head of the Department of Pathophysiology and Transplantation at the University of Milan in Italy
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18
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Sullivan KL, Babicz MA, Woods SP. Verbal Learning Mediates the Relationship Between Executive Functions and a Laboratory Task of Medication Management in HIV Disease. Arch Clin Neuropsychol 2021; 36:507-516. [PMID: 33009799 DOI: 10.1093/arclin/acaa082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/22/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Impairments in executive functions and learning are common in HIV disease and increase the risk of nonadherence to antiretroviral therapy. The mixed encoding/retrieval profile of HIV-associated deficits in learning and memory is largely driven by dysregulation of prefrontal systems and related executive dysfunction. This study tested the hypothesis that learning may be one pathway by which executive dysfunction disrupts medication management in people living with HIV (PLWH). METHOD A total of 195 PLWH completed a performance-based laboratory task of medication management capacity and clinical measures of executive functions, verbal learning and memory, and motor skills. RESULTS Executive functions were significantly associated with verbal learning and medication management performance. In a model controlling for education, learning significantly mediated the relationship between executive functions and medication management, and this mediation was associated with a small effect size. In particular, executive dysfunction was associated with diminished use of higher-order learning strategies. Alternate models showed that executive functions did not mediate the relationship between learning and medication management nor did motor skills mediate the relationship between executive functions and medication management. CONCLUSIONS PLWH with executive dysfunction may demonstrate difficulty in learning new information, potentially due to ineffective strategy use, which may in turn put them at a higher risk for problems managing their medications in the laboratory. Future studies may wish to investigate whether compensatory neurocognitive training (e.g., using more effective learning strategies) may improve medication management among PLWH.
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Affiliation(s)
- Kelli L Sullivan
- Department of Psychology, University of Houston, Houston, TX, USA
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19
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Tureson K, Byrd DA, Guzman V, Summers AC, Morris EP, Mindt MR. The impact of sociocultural factors on prospective memory performance in HIV+ Latinx adults. Neuropsychology 2021; 35:411-422. [PMID: 34043391 PMCID: PMC10284210 DOI: 10.1037/neu0000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Prospective memory (PM), a salient component of neurocognitive functioning for people living with HIV (PLH), is necessary for planning and coordinating health-related behaviors and instrumental tasks of daily living. However, little is known regarding the impact of sociocultural factors on PM in diverse populations, particularly Latinx PLH. The aim of this study was to examine ethnic group differences and sociocultural factors related to PM. METHOD The sample of 127 PLH (91 Latinx and 36 non-Latinx white) completed measures of quality of education, socioeconomic status (SES), and a validated PM measure, the Memory for Intentions Screening Test (MIST). The Latinx group also completed a bicultural acculturation measure. RESULTS Results revealed the Latinx and the non-Latinx white groups did not significantly differ in overall MIST performance (all p > .05). In the entire sample, better quality of education was associated with better MIST performance (all p < .05). Within the Latinx group, higher Latinx acculturation was associated with worse MIST performance (p = .02), whereas higher U.S. acculturation was associated with better MIST performance at a trend level (p = .07). Multivariate regressions revealed quality of education and Latinx acculturation significantly predicted MIST performance and PM errors (all p < .05). SES was not related to the MIST (all p > .10). CONCLUSIONS In sum, clinicians must take sociocultural factors into consideration when working with Latinx PLH, as these factors influence cognitive functions (i.e., PM) vital to health-related behaviors. Integrating culturally-informed psychoeducation into care plans is an imperative first step. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Kayla Tureson
- Department of Psychology, University of Southern California, Los Angeles, CA
| | - Desiree A. Byrd
- Department of Psychology, Queens College, Queens, NY
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vanessa Guzman
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
| | - Angela C. Summers
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
| | - Emily P. Morris
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Monica Rivera Mindt
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
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20
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Nightingale S, Dreyer AJ, Saylor D, Gisslén M, Winston A, Joska JA. Moving on from HAND: why we need new criteria for cognitive impairment in people with HIV and a proposed way forward. Clin Infect Dis 2021; 73:1113-1118. [PMID: 33904889 DOI: 10.1093/cid/ciab366] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Indexed: 12/31/2022] Open
Abstract
HIV-associated neurocognitive disorders (HAND) criteria are frequently used to describe cognitive impairment in people with HIV (PWH) across diverse populations globally. These criteria typically find 20-60% of PWH meet criteria for HAND, which does not tally with clinical observations in the modern era that cognitive disorders present relatively infrequently. Most with HAND have asymptomatic neurocognitive impairment (ANI), however the significance of low cognitive test performance without symptoms is uncertain. Methods underlying HAND criteria carry a false positive rate that can exceed 20%. Comorbidities, education and complex socioeconomic factors can influence cognitive test performance, further increasing the potential for misclassification. We propose a new framework to characterise cognitive impairment in PWH which requires a clinical history and acknowledges the multifactorial nature of low cognitive test performance. This framework is intended to be applicable across diverse populations globally, be more aligned with clinical observations and more closely represent HIV brain pathology.
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Affiliation(s)
- Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, South Africa
| | - Anna J Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, South Africa
| | - Deanna Saylor
- University Teaching Hospital, Lusaka, Zambia.,Department of Neurology, Johns Hopkins University School of Medicine, USA
| | - Magnus Gisslén
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK.,Clinical Trials, Winston Churchill Wing, St Mary's Hospital, London, UK
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, South Africa
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21
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Gouse H, Masson CJ, Henry M, Thomas KGF, Robbins RN, Kew G, London L, Joska JA, Marcotte TD. The Impact of HIV-Associated Neurocognitive Impairment on Driving Performance in Commercial Truck Drivers. AIDS Behav 2021; 25:689-698. [PMID: 32910354 DOI: 10.1007/s10461-020-03033-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Driving ability can be diminished amongst people with HIV with associated neurocognitive impairment (NCI). We explore the relationship between HIV status, NCI and driving ability in professional truck drivers. Forty male professional drivers (20 HIV-positive; mean age = 39.20 ± 7.05) completed a neuropsychological test battery, two driving simulator tasks that assessed driving ability, and a driving history and habits questionnaire. A higher proportion of HIV-positive drivers exhibited impaired overall cognitive performance (p ≤ 0.001). Overall, drivers with NCI (defined as z ≤ 1.00) were more likely than those without NCI to crash (p = 0.002). There were no significant between-group (HIV-positive versus HIV-negative) differences with regard to self-reported on-road driving events. Professional drivers with NCI, as measured on a driving simulator, are at increased risk of making driving errors under high-risk conditions compared to their neurocognitively normal counterparts. These data should inform driver health management with regard to annual medical screening and surveillance.
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Affiliation(s)
- H Gouse
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - C J Masson
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - M Henry
- Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - K G F Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - R N Robbins
- HIV Center for Clinical and Behavioral Science, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - G Kew
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - L London
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J A Joska
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - T D Marcotte
- HIV Neurovehavioral Research Program, Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Konstantinopoulou E, Ioannidis P, Kiosseoglou G, Aretouli E. Inhibitory control is associated with medication adherence in young HIV patients without comorbidities. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1467-1475. [PMID: 33631076 DOI: 10.1080/23279095.2021.1890594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In the present study we evaluated the incremental contribution of executive cognition (EC) subprocesses to antiretroviral medication adherence. METHOD A comprehensive EC test battery assessing updating/working memory, mental flexibility, and inhibitory control, along with measures assessing non-executive cognitive functions were completed by 100 individuals with HIV. Medication adherence was determined via a visual analogue self-report scale and the Medication Adherence Questionnaire. Potential predictors, including demographic and clinical characteristics and neuropsychological performances on EC and other cognitive tasks were regressed to medication adherence. Predictive variables related to executive processes were added in the final block of the hierarchical regression model in order to assess their incremental predictive ability on medication adherence. RESULTS 23% of the variance in the visual analogue scale was explained by treatment complexity, memory and EC performance. A measure of inhibitory control, in particular, predicted self-reported medication adherence above and beyond demographic, clinical and other cognitive factors. CONCLUSIONS The contribution of EC to self-reported medication adherence in young seropositive adults was limited, but inhibitory control was associated with proper medication management above and beyond demographic, clinical and other cognitive functions.
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Affiliation(s)
- Eleni Konstantinopoulou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Grigoris Kiosseoglou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Aretouli
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece.,School of the Social Sciences, University of Ioannina, Ioannina, Greece
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Abstract
Approximately 30-50% of persons living with HIV manifest some degree of neurocognitive impairment. Even mild-to-moderate forms of HIV-associated neurocognitive disorders (HAND) can result in difficulties with everyday functioning, such as suboptimal medication adherence and impaired driving. Despite the pervasive presence and consequences of HAND, there is a significant unmet need to develop effective behavioral strategies to reduce the incidence and consequences of HAND. Although there is an absence of evidence-based behavioral interventions specific to HAND, the literature reviewed in this chapter suggest the following modifiable lifestyle factors as intervention targets: physical activity, diet, sleep, and antiretroviral medication adherence. Adoption and maintenance of these healthy lifestyle factors may reduce inflammation and oxidative stress, which, in turn, may reduce the incidence and/or severity of HAND.
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Affiliation(s)
- Jessica L Montoya
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Brook Henry
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- HIV Neurobehavioral Research Program, San Diego, CA, USA.
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24
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Britton MK, Porges EC, Bryant V, Cohen RA. Neuroimaging and Cognitive Evidence for Combined HIV-Alcohol Effects on the Central Nervous System: A Review. Alcohol Clin Exp Res 2020; 45:290-306. [PMID: 33296091 DOI: 10.1111/acer.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/29/2020] [Indexed: 12/27/2022]
Abstract
Alcohol use disorder (AUD) among people living with HIV (PLWH) is a significant public health concern. Despite the advent of effective antiretroviral therapy, up to 50% of PLWH still experience worsened neurocognition, which comorbid AUD exacerbates. We report converging lines of neuroimaging and neuropsychological evidence linking comorbid HIV/AUD to dysfunction in brain regions linked to executive function, learning and memory, processing speed, and motor control, and consequently to impairment in daily life. The brain shrinkage, functional network alterations, and brain metabolite disruption seen in individuals with HIV/AUD have been attributed to several interacting pathways: viral proteins and EtOH are directly neurotoxic and exacerbate each other's neurotoxic effects; EtOH reduces antiretroviral adherence and increases viral replication; AUD and HIV both increase gut microbial translocation, promoting systemic inflammation and HIV transport into the brain by immune cells; and HIV may compound alcohol's damaging effects on the liver, further increasing inflammation. We additionally review the neurocognitive effects of aging, Hepatitis C coinfection, obesity, and cardiovascular disease, tobacco use, and nutritional deficiencies, all of which have been shown to compound cognitive changes in HIV, AUD, and in their comorbidity. Finally, we examine emerging questions in HIV/AUD research, including genetic and cognitive protective factors, the role of binge drinking in HIV/AUD-linked cognitive decline, and whether neurocognitive and brain functions normalize after drinking cessation.
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Affiliation(s)
- Mark K Britton
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Eric C Porges
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Vaughn Bryant
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, (VB), University of Florida, Gainesville, Florida, USA
| | - Ronald A Cohen
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
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25
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Salahuddin M, Manzar MD, Hassen HY, Unissa A, Abdul Hameed U, Spence DW, Pandi-Perumal SR. Prevalence and Predictors of Neurocognitive Impairment in Ethiopian Population Living with HIV. HIV AIDS (Auckl) 2020; 12:559-572. [PMID: 33116918 PMCID: PMC7568595 DOI: 10.2147/hiv.s260831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Modern antiretroviral therapy has extended the life expectancies of people living with HIV; however, the prevention and treatment of their associated neurocognitive decline have remained a challenge. Consequently, it is desirable to investigate the prevalence and predictors of neurocognitive impairment to help in targeted screening and disease prevention. MATERIALS AND METHODS Two hundred and forty-four people living with HIV were interviewed in a study using a cross-sectional design and the International HIV Dementia Scale (IHDS). Additionally, the sociodemographic, clinical, and psychosocial characteristics of the patients were recorded. Chi-square and binary logistic regression analysis were used to determine the level of significance among the independent risk factors and probable neurocognitive impairment. RESULTS The point prevalence of neurocognitive impairment was found to be 39.3%. Participants' characteristics of being older than 40 years (AOR= 2.81 (95% CI; 1.11-7.15)), having a history of recreational drug use (AOR= 13.67 (95% CI; 6.42-29.13)), and being non-compliant with prescribed medications (AOR= 2.99 (95% CI; 1.01-8.87)) were independent risk factors for neurocognitive impairment. CONCLUSION The identification of predictors, in the Ethiopian people living with HIV, may help in the targeted screening of vulnerable groups during cART follow-up visits. This may greatly help in strategizing and implementation of the prevention program, more so, because (i) HIV-associated neurocognitive impairment is an asymptomatic condition for considerable durations, and (ii) clinical trials on neurocognitive impairment therapies have been unsuccessful.
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Affiliation(s)
- Mohammed Salahuddin
- Department of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University (Mizan Campus), Mizan, Ethiopia
- Pharmacology Division, Department of BioMolecular Sciences, University of Mississippi, Oxford, Mississippi, USA
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah11952, Saudi Arabia
| | - Hamid Yimam Hassen
- Department of Public Health, College of Health Sciences, Mizan Tepi University, (Mizan Campus), Mizan, Ethiopia
- Department of Primary and Interdisciplinary Care, College of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Aleem Unissa
- Malla Reddy College of Pharmacy, Hyderabad, Telangana, India
| | - Unaise Abdul Hameed
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Rivera Mindt M, Arentoft A, Tureson K, Summers AC, Morris EP, Guzman V, Aghvinian MN, Alvarez K, Robbins RN, Savin MJ, Byrd D. Disparities in Electronically Monitored Antiretroviral Adherence and Differential Adherence Predictors in Latinx and Non-Latinx White Persons Living with HIV. AIDS Patient Care STDS 2020; 34:344-355. [PMID: 32757979 PMCID: PMC7415218 DOI: 10.1089/apc.2019.0256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Antiretroviral therapy (ART) adherence is vital for optimal HIV treatment. However, there is limited ART adherence research on the US Latinx population, who are at increased risk for HIV infection and worse HIV health outcomes. This study examined electronically measured ART adherence (Medication Event Monitoring System) and its association with demographic, clinical, neurocognitive, and sociocultural variables in Latinx and non-Latinx white (NLW) persons living with HIV [PLWH (N = 128)]. Latinx participants demonstrated worse adherence than NLW participants (p = 0.04). Linear regressions revealed different predictors of adherence. Among Latinx participants, recent cocaine use, stress, and, unexpectedly, higher US acculturation predicted worse adherence (ps < 0.05). Among NLW participants, recent cocaine use predicted worse adherence (p < 0.05). Intergroup comparisons within the Latinx group were not conducted due to subsample size. Thus, ethnicity, sociocultural variables, and cocaine use are important considerations for ART adherence, and poor ART adherence may be one pathway explaining worse outcomes in Latinx PLWH. Culturally tailored adherence interventions incorporating substance use treatment, acculturation, and stress management are warranted to improve health outcomes.
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Affiliation(s)
- Monica Rivera Mindt
- Department of Psychology, Fordham University, Bronx, New York, USA
- Department of Neurology and Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alyssa Arentoft
- Department of Psychology, California State University Northridge, Northridge, California, USA
| | - Kayla Tureson
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Angela C. Summers
- Department of Psychology, Fordham University, Bronx, New York, USA
- Department of Neurology and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily P. Morris
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Vanessa Guzman
- Department of Psychology, Fordham University, Bronx, New York, USA
- Department of Neurology and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maral N. Aghvinian
- Department of Psychology, Fordham University, Bronx, New York, USA
- Department of Neurology and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karen Alvarez
- Department of Psychology, California State University Northridge, Northridge, California, USA
| | - Reuben N. Robbins
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York, USA
| | - Micah J. Savin
- Department of Psychology, Fordham University, Bronx, New York, USA
- Department of Neurology and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Desiree Byrd
- Department of Neurology and Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychology, Queens College, The City University of New York, Queens, New York, USA
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Attention/Working Memory, Learning and Memory in Adult Cameroonians: Normative Data, Effects of HIV Infection and Viral Genotype. J Int Neuropsychol Soc 2020; 26:607-623. [PMID: 32066518 PMCID: PMC8582275 DOI: 10.1017/s1355617720000120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE There is lack of Cameroonian adult neuropsychological (NP) norms, limited knowledge concerning HIV-associated neurocognitive disorders in Sub-Saharan Africa, and evidence of differential inflammation and disease progression based on viral subtypes. In this study, we developed demographically corrected norms and assessed HIV and viral genotypes effects on attention/working memory (WM), learning, and memory. METHOD We administered two tests of attention/WM [Paced Auditory Serial Addition Test (PASAT)-50, Wechsler Memory Scale (WMS)-III Spatial Span] and two tests of learning and memory [Brief Visuospatial Memory Test-Revised (BVMT-R), Hopkins Verbal Learning Test-Revised (HVLT-R)] to 347 HIV+ and 395 seronegative adult Cameroonians. We assessed the effects of viral factors on neurocognitive performance. RESULTS Compared to controls, people living with HIV (PLWH) had significantly lower T-scores on PASAT-50 and attention/WM summary scores, on HVLT-R total learning and learning summary scores, on HVLT-R delayed recall, BVMT-R delayed recall and memory summary scores. More PLWH had impairment in attention/WM, learning, and memory. Antiretroviral therapy (ART) and current immune status had no effect on T-scores. Compared to untreated cases with detectable viremia, untreated cases with undetectable viremia had significantly lower (worse) T-scores on BVMT-R total learning, BVMT-R delayed recall, and memory composite scores. Compared to PLWH infected with other subtypes (41.83%), those infected with HIV-1 CRF02_AG (58.17%) had higher (better) attention/WM T-scores. CONCLUSIONS PLWH in Cameroon have impaired attention/WM, learning, and memory and those infected with CRF02_AG viruses showed reduced deficits in attention/WM. The first adult normative standards for assessing attention/WM, learning, and memory described, with equations for computing demographically adjusted T-scores, will facilitate future studies of diseases affecting cognitive function in Cameroonians.
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Rubtsova AA, Sabbag S, Sundermann E, Nguyen AL, Ellis RJ, Moore DJ, Letendre S, Jeste DV, Marquine MJ. Frailty and Neurocognitive Impairment: Impacts on Quality of Life in HIV. J Assoc Nurses AIDS Care 2020; 31:290-300. [PMID: 31789684 PMCID: PMC7192758 DOI: 10.1097/jnc.0000000000000142] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Little is known about the effects of aging-related conditions on health-related quality of life (HRQOL) among people living with HIV (PLWH). The purpose of our study was to examine the independent effects of neurocognitive impairment (NCI) and frailty and the interactive effects with HIV serostatus on HRQOL. Our sample consisted of 121 adults (63 PLWH and 58 HIV-uninfected) participating in the Multi-Dimensional Successful Aging among HIV-Infected Adults study at the University of California, San Diego. HRQOL was measured with the Medical Outcome Study 36-Item Short Form Health Survey scale. We found that frailty was significantly associated with HRQOL (p < .001) in the overall sample, and this effect was significantly stronger for PLWH than HIV-uninfected adults. NCI was not significantly associated with HRQOL in our sample. Frailty may be a particularly important factor in HRQOL for PLWH, highlighting the need for prevention and intervention strategies to mitigate the risks for frailty.
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Affiliation(s)
- Anna A Rubtsova
- Anna A. Rubtsova, PhD, MA, MSc, is an Assistant Research Professor, Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA. Samir Sabbag, MD, is an Assistant Professor, Department of Psychiatry, University of Miami, Miami, Florida, USA. Erin Sundermann, PhD, is an Assistant Project Scientist, Department of Psychiatry, University of California, San Diego, California, USA. Annie L. Nguyen, PhD, is an Assistant Professor, Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA. Ronald J. Ellis, MD, PhD, is a Professor, Departments of Neuroscience and Psychiatry, University of California, San Diego, California, USA. David J. Moore, PhD, is an Associate Professor, Department of Psychiatry, University of California, San Diego, California, USA. Scott Letendre, MD, is a Professor, Department of Medicine, University of California, San Diego, California, USA. Dilip V. Jeste, MD, is a Distinguished Professor, Departments of Neuroscience and Psychiatry, University of California, San Diego, California, USA. María J. Marquine, PhD, is an Assistant Professor, Department of Psychiatry, University of California, San Diego, California, USA
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Michael H, Mpofana T, Ramlall S, Oosthuizen F. The Role of Brain Derived Neurotrophic Factor in HIV-Associated Neurocognitive Disorder: From the Bench-Top to the Bedside. Neuropsychiatr Dis Treat 2020; 16:355-367. [PMID: 32099373 PMCID: PMC6999762 DOI: 10.2147/ndt.s232836] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
Abstract
Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) remains prevalent in the anti-retroviral (ART) era. While there is a complex interplay of many factors in the neuropathogenesis of HAND, decreased neurotrophic synthesis has been shown to contribute to synaptic degeneration which is a hallmark of HAND neuropathology. Brain derived neurotrophic factor (BDNF) is the most abundant and synaptic-promoting neurotrophic factor in the brain and plays a critical role in both learning and memory. Reduced BDNF levels can worsen neurocognitive impairment in HIV-positive individuals across several domains. In this paper, we review the evidence from pre-clinical and clinical studies showing the neuroprotective roles of BDNF against viral proteins, effect on co-morbid mental health disorders, altered human microbiome and ART in HAND management. Potential applications of BDNF modulation in pharmacotherapeutic, cognitive and behavioral interventions in HAND are also discussed. Finally, research gaps and future research direction are identified with the aim of helping researchers to direct efforts to make these BDNF driven interventions improve the quality of life of patients living with HAND.
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Affiliation(s)
- Henry Michael
- Discipline of Pharmaceutical Sciences, School of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Thabisile Mpofana
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Suvira Ramlall
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | - Frasia Oosthuizen
- Discipline of Pharmaceutical Sciences, School of Health Science, University of KwaZulu-Natal, Durban, South Africa
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30
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Arce Rentería M, Byrd D, Coulehan K, Miranda C, Fuentes A, Rosario AK, Morris EP, Rivera Mindt M. Neurocognitive intra-individual variability within HIV+ adults with and without current substance use. Neuropsychology 2019; 34:321-330. [PMID: 31886690 DOI: 10.1037/neu0000612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE HIV infection and current substance use (SU) are linked to cognitive and functional deficits, yet findings on their combined effects are mixed. Neurocognitive intraindividual variability, measured as dispersion of scores across a neuropsychological battery, is associated with worse cognitive outcomes and functional deficits among HIV+ adults but has not been studied in the context of HIV+ adults with current SU. We hypothesized that, among HIV+ adults, current SU would be associated with greater dispersion, that greater dispersion would be associated with worse medication adherence, and that this relationship would be worse among substance users. METHOD Forty HIV+ adults completed neuropsychological, psychiatric, SU, and medical evaluations and an electronic medication adherence measure. General linear models evaluated the main effect of SU status on neurocognitive dispersion, and models stratified by SU status evaluated the effect of dispersion on medication adherence, adjusting for relevant covariates. RESULTS The SU+ group showed greater dispersion than did the SU- group, t(38) = 2.74, p = .049, d = 0.81, but this association did not survive multiple comparisons. Stratified analyses indicated a negative relationship between dispersion and medication adherence among the SU+ group but not in the SU- group; however, this effect was reduced after accounting for depressive symptoms. CONCLUSIONS We found preliminary evidence that current SU is associated with greater neurocognitive dispersion among HIV+ adults. SU and neurocognitive dispersion may have a synergistic effect on medication adherence; however, this effect is largely accounted for by depressive symptoms. Future research should examine progression of dispersion in HIV and consequent neurocognitive and functional deficits in those with current SU. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Better executive function is independently associated with full HIV suppression during combination therapy. AIDS 2019; 33:2309-2316. [PMID: 31764096 DOI: 10.1097/qad.0000000000002348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE HIV-associated neurocognitive impairment continues to be prevalent and clinically relevant. We examined the relationship between neurocognition and full plasma HIV RNA suppression among study participants over a 15-year period at a large research program. DESIGN/METHODS We analyzed the combined prospective studies of the HIV Neurobehavioral Research Program at the University of California at San Diego. Participants were eligible for analysis if on three drug combination antiretroviral therapy with comprehensive neuropsychological testing results. Participants who reported recent nonadherence were excluded. The primary outcome was plasma HIV RNA of 50 copies/ml or less. Generalized estimating equation was used to assess for associations with full virologic suppression taking into account longitudinal visits. RESULTS There were 1943 participants at baseline, of whom 69.4% had plasma HIV RNA of 50 copies/ml or less. Participants with full suppression were slightly older, less likely to abuse cocaine, and had significantly better executive function. Multivariate analysis with incorporation of longitudinal visits (total = 5555) confirmed current cocaine abuse to be strongly associated with lack of virologic suppression (odds ratio = 0.45, 95% confidence interval = 0.31-0.63). In contrast, increasing age, increasing years of HIV infection, and increasing executive function (odds ratio = 1.18 for T score change of 10, 95% confidence interval = 1.07-1.30) were associated with full virologic suppression. Lack of virologic suppression at baseline was associated with a significant subsequent decline in executive function. CONCLUSION In a 15-year research cohort of almost 2000 HIV-infected individuals on combination antiretroviral therapy, better executive function was associated with full virologic suppression, possibly as a result rather than a cause.
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Litvin PY, Siders CA, Waite EN, Woo E, Romero E, Foley J, Ettenhofer ML, Gooding AL, Castellon S, Hinkin C, Wright MJ. Recent cocaine use and memory impairment in HIV. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:685-696. [PMID: 31661322 DOI: 10.1080/23279095.2019.1683562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Both Human Immunodeficiency Virus (HIV) and cocaine use have been associated with impairment in neuropsychological functioning. The high comorbidity between HIV and cocaine use highlights the importance of ascertaining whether there is a compounding effect of cocaine use in individuals with HIV. Among neuropsychological domains impacted by HIV, verbal memory deficits have received substantial attention partly because they have been associated with declines in functional status in HIV positive individuals. We collected California Verbal Learning Test-II data from HIV participants who met lifetime diagnostic criteria of cocaine abuse and/or dependence (HIV/CocDx+, N = 80 & HIV/CocDx-, N = 30, respectively) and those with and without recent cocaine use, which was confirmed by toxicology analysis (HIV/Coc+, N = 56 & HIV/Coc-, N = 57, respectively). The Item Specific Deficit Approach (ISDA) was employed to determine any additional cocaine-associated deficits in encoding, consolidation, and retrieval, which attempts to control for potential confounding factors of memory such as attention. Using conventional methods of evaluating memory profiles, we found that the HIV/Coc + group demonstrated worse learning, immediate and delayed free recall, and recognition in contrast to the HIV/Coc - group; although using the ISDA, we found that encoding was the only significant difference between HIV/Coc + and HIV/Coc-participant, with HIV/Coc - performing better. Our data suggest that for individuals with HIV, cocaine use is associated with a temporary decline in verbal memory, is characterized by greater encoding deficits, and these effects may reduce with abstinence. Clinically, our findings suggest that reduced encoding is the likely contributor to verbal memory decline in HIV/Coc + and these effects are partially reversible-at least to the level of their HIV/Coc - counterparts.
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Affiliation(s)
- Pavel Y Litvin
- Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Craig A Siders
- Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA.,California State University Long Beach, Long Beach, CA, USA
| | - Erin N Waite
- Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Ellen Woo
- California State University Fresno, Fresno, CA, USA
| | - Elizabeth Romero
- Veterans Administration Greater Los Angeles Healthcare System, West Lost Angeles Medical Center, Los Angeles, CA, USA
| | - Jessica Foley
- Memory & Aging Center, University California San Francisco, San Francisco, CA, USA
| | - Mark L Ettenhofer
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Amanda L Gooding
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Steven Castellon
- Veterans Administration Greater Los Angeles Healthcare System, West Lost Angeles Medical Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Charles Hinkin
- Veterans Administration Greater Los Angeles Healthcare System, West Lost Angeles Medical Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Matthew J Wright
- Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Relationships between cognition, function, and quality of life among HIV+ Canadian men. Qual Life Res 2019; 29:37-55. [PMID: 31502189 DOI: 10.1007/s11136-019-02291-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To estimate the extent to which HIV-related variables, cognition, and other brain health factors interrelate with other HIV-associated symptoms to influence function, health perception, and QOL in older HIV+ men in Canada. DESIGN Cross-sectional structural equation modelling (SEM) of data from the inaugural visit to the Positive Brain Health Now Cohort. SETTING HIV clinics at 5 Canadian sites. SUBJECTS 707 men, age ≥ 35 years, HIV+ for at least one year, without clinically diagnosed dementia. MAIN OUTCOME MEASURES Five latent and 21 observed variables from the World Health Organization's biopsychosocial model for functioning and disability and the Wilson-Cleary Model were analysed. SEM was used to link disease factors to symptoms, impairments, function, health perception, and QOL with a focus on cognition. RESULTS QOL was explained directly by depression, social role, health perception, social support, and quality of the environment. Measured cognitive performance had direct effects on activity/function and indirect effects on participation, HP and QOL, acting through self-reported cognitive difficulties and meaningful activities. CONCLUSION The biopsychosocial model showed good fit, with RMSEA < 0.05. This is the first time the full model has been tested in HIV. All of the domains included in the model are theoretically amenable to intervention and many have evidence-based interventions that could be harnessed to improve QOL.
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Yildirim C, Garvie PA, Chernoff M, Wilkins ML, Patton ED, Williams PL, Nichols SL. The Role of Pharmacy Refill Measures in Assessing Adherence and Predicting HIV Disease Markers in Youth with Perinatally-Acquired HIV (PHIV). AIDS Behav 2019; 23:2109-2120. [PMID: 30929147 DOI: 10.1007/s10461-019-02468-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Antiretroviral (ARV) adherence is critical in monitoring disease response in youth with perinatally-acquired HIV (PHIV). We used pharmacy refill (PR) information for PHIV youth from the PHACS Memory Sub-study to calculate medication availability over 2, 4, and 6 months. PR, a proxy of adherence, was compared with self-reported 7-day adherence in predicting suppressed viral load (SVL < 400 copies/mL) and higher CD4% (≥ 25%). Among 159 PHIV youth, 79% were adherent by 7-day recall, and 62, 55, and 48% by PR over 2, 4, and 6 months, respectively. Agreement between 7-day recall and PR adherence was weak (Kappa = 0.09-0.25). In adjusted logistic regression models, adherence showed associations with SVL for 7-day recall (OR 2.78, 95% CI 1.08, 7.15) and all PR coverage periods (6-month: OR 3.24, 95% CI 1.22, 8.65). Similar associations were observed with higher CD4%. PR measures were predictive of study retention. Findings suggest a possibly independent role of PR adherence measures.
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Affiliation(s)
- Cenk Yildirim
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, FXB Building 5th floor, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Patricia A Garvie
- Research Department, Children's Diagnostic & Treatment Center, Fort Lauderdale, FL, USA
| | - Miriam Chernoff
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, FXB Building 5th floor, 677 Huntington Ave, Boston, MA, 02115, USA
| | | | | | - Paige L Williams
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, FXB Building 5th floor, 677 Huntington Ave, Boston, MA, 02115, USA
- Departments of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sharon L Nichols
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Drive, Mail Code 0935, La Jolla, CA, 92093, USA.
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Pennar A, Naar S, Woods S, Nichols S, Outlaw A, Ellis D. Promoting resilience through neurocognitive functioning in youth living with HIV. AIDS Care 2019; 30:59-64. [PMID: 30714388 DOI: 10.1080/09540121.2019.1576851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Using a phased model of intervention development, we developed an intervention to promote resilience in youth living with HIV via improved neurocognitive resources. First, youth completed a naturalistic prospective memory (PM) task and were randomized into a visualization condition or control condition. Next, 47 of these participants completed another naturalistic PM task and were randomized into Calendaring condition, an Alarm condition, a Combined condition, or a Control condition. Youth with low PM demonstrated observable gains from the visualization technique. Youth in the Combined Calendaring and Alarm condition demonstrated significantly better performance than participants in the Control and Calendaring conditions. In a Proof-of-Concept study with 16 youth, the previous findings were translated into a single session in-person intervention followed by tailored text messaging to improve adherence and viral load via improved neurocognitive resources. The resulting intervention showed a signal of effect with viral load reductions in youth with available data. Targeting compensatory strategies to enhance neurocognitive functioning may promote resilience and health outcomes. A randomized pilot study with a control condition is the next step.
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Affiliation(s)
- Amy Pennar
- a Center for Translational Behavioral Science , Florida State University , Tallahassee , FL , USA
| | - Sylvie Naar
- a Center for Translational Behavioral Science , Florida State University , Tallahassee , FL , USA
| | - Steven Woods
- b Department of Psychology , University of Houston , Houston , TX , USA.,c Department of Psychiatry , University of California , San Diego , CA , USA
| | - Sharon Nichols
- d Department of Neurosciences , University of California , San Diego , CA , USA
| | - Angulique Outlaw
- e Department of Family Medicine and Public Health Sciences , Wayne State University , Detroit , MI , USA
| | - Deborah Ellis
- e Department of Family Medicine and Public Health Sciences , Wayne State University , Detroit , MI , USA
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Kordovski VM, Tierney SM, Woods SP. Conceptualizing and Assessing Everyday Functioning in the Context of HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci 2019; 50:329-346. [PMID: 30610667 DOI: 10.1007/7854_2018_78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Combination antiretroviral therapy has reduced the rates of severe HIV-associated neurocognitive disorders (HAND), but the prevalence of milder forms of HAND that can affect everyday functioning remains high. As HIV-infected adults approach near-normal life expectancies, they may become increasingly susceptible to declines in everyday functioning secondary to a variety of physical and mental factors, including HAND. Although impairments in everyday functioning are a hallmark of HAND diagnoses and can adversely influence quality of life, there are no gold standard measures of this fundamentally important and complex construct. This chapter provides a brief review of the various self-report, clinician-rated, and performance-based methods by which everyday functioning is measured in the setting of HIV disease, including global activities of daily living and specific domains of medication adherence, financial management, automobile driving, and vocational functioning.
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Shahani L, Salazar L, Woods SP, Hasbun R. Baseline Neurocognitive Functioning Predicts Viral Load Suppression at 1-Year Follow-Up Among Newly Diagnosed HIV Infected Patients. AIDS Behav 2018; 22:3209-3213. [PMID: 29350337 DOI: 10.1007/s10461-018-2025-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The current prospective observational study evaluated the impact of baseline neurocognitive impairment on future viral load suppression among antiretroviral medication naive persons newly diagnosed with HIV infection. We used the Montreal Cognitive Assessment (MoCA) score less than 26, to identify patients with neurocognitive deficits. Of the 138 patients enrolled; virologic suppression was seen in 61% of the participants, while 72% of the participants had a MoCA score less than 26 at baseline. Variables significantly associated with low MoCA score included higher age (p < 0.01) and presence of depression (p < 0.01). After adjusting for these variables, MoCA score less than 26 was significantly associated with a higher risk of failing achieve viral load suppression (adjusted OR 2.7; 95% CI 1.09-6.69). Baseline neurocognitive deficit as measured by MoCA was associated with a higher risk for failing to achieve viral load suppression at one-year follow-up.
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Affiliation(s)
- Lokesh Shahani
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, 1941 East Road, Houston, TX, 77054, USA.
| | - Lucrecia Salazar
- Division of Infectious Diseases, University of Texas Health Science Center, Houston, TX, USA
| | - Steven P Woods
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Rodrigo Hasbun
- Division of Infectious Diseases, University of Texas Health Science Center, Houston, TX, USA
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Pennar A, Naar S, Woods S, Nichols S, Outlaw A, Ellis D. Promoting resilience through neurocognitive functioning in youth living with HIV. AIDS Care 2018. [DOI: https:/doi:10.1080/09540121.2019.1576851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Amy Pennar
- Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, USA
| | - Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, USA
| | - Steven Woods
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Angulique Outlaw
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA
| | - Deborah Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA
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Memory Impairment in HIV-Infected Individuals with Early and Late Initiation of Regular Marijuana Use. AIDS Behav 2018; 22:1596-1605. [PMID: 28884250 DOI: 10.1007/s10461-017-1898-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Marijuana use is disproportionately prevalent among HIV-infected individuals. The strongest neurocognitive effect of marijuana use is impairment in the domain of memory. Memory impairment is also high among HIV-infected persons. The present study examined 69 HIV-infected individuals who were stratified by age of regular marijuana initiation to investigate how marijuana use impacts neurocognitive functioning. A comprehensive battery assessed substance use and neurocognitive functioning. Findings indicated early onset marijuana users (regular use prior to age 18), compared to non-marijuana users and late onset marijuana users (regular use at age 18 or later), were over 8 times more likely to have learning impairment and nearly 4 times more likely to have memory impairment. A similar pattern of early onset marijuana users performing worse in learning emerged when examining domain deficit scores. The potential for early onset of regular marijuana use to exacerbate already high levels of memory impairment among HIV-infected persons has important clinical implications, including increased potential for medication non-adherence and difficulty with independent living.
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Robbins RN, Gouse H, Brown HG, Ehlers A, Scott TM, Leu CS, Remien RH, Mellins CA, Joska JA. A Mobile App to Screen for Neurocognitive Impairment: Preliminary Validation of NeuroScreen Among HIV-Infected South African Adults. JMIR Mhealth Uhealth 2018; 6:e5. [PMID: 29305338 PMCID: PMC5775487 DOI: 10.2196/mhealth.9148] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 11/20/2022] Open
Abstract
Background Neurocognitive impairment (NCI) is one of the most common complications of HIV infection, and has serious medical and functional consequences. South Africa has 7 million people living with HIV (PLHIV) with up to three-quarters of antiretroviral therapy (ART)-naïve individuals having NCI. South Africa’s health system struggles to meet the care needs of its millions of PLHIV; screening for NCI is typically neglected due to limited clinical staff trained to administer, score, and interpret neuropsychological tests, as well as long test batteries and limited screening tools for South African populations. Without accurate, clinically useful, and relatively brief NCI screening tests that can be administered by all levels of clinical staff, critical opportunities to provide psychoeducation, behavioral planning, additional ART adherence support, and adjuvant therapies for NCI (when they become available) are missed. To address these challenges and gap in care, we developed an mHealth app screening tool, NeuroScreen, to detect NCI that can be administered by all levels of clinical staff, including lay health workers. Objective The purpose of this study was to examine sensitivity and specificity of an adapted version of NeuroScreen to detect NCI (as determined by a gold standard neuropsychological test battery administered by a trained research psychometrist) among HIV-infected South Africans when administered by a lay health worker. Methods A total of 102 HIV-infected black South African adults who had initiated ART at least 12 months prior were administered NeuroScreen and a gold standard neuropsychological test battery in the participants’ choice of language (ie, English or isiXhosa). Three composite z scores were calculated for NeuroScreen: (1) sum of all individual test scores, (2) sum of all individual test scores and error scores from four tests, and (3) sum of four tests (abbreviated version). Global deficit scores were calculated for the gold standard battery where a score of 0.5 or greater indicated the presence of NCI. Results The mean age of participants was 33.31 (SD 7.46) years, most (59.8%, 61/102) had at least 12 years of education, and 81.4% (83/102) of the sample was female. Gold standard test battery results indicated that 26.5% (27/102) of the sample had NCI. Sensitivity and specificity of age-, education-, and sex-adjusted NeuroScreen scores were 81.48% and 74.67% for composite score 1, 81.48% and 81.33% for composite score 2, and 92.59% and 70.67% for composite score 3, respectively. Conclusions NeuroScreen, a highly automated, easy-to-use, tablet-based screening test to detect NCI among English- and isiXhosa-speaking South African HIV patients demonstrated robust sensitivity and specificity to detect NCI when administered by lay health workers. NeuroScreen could help make screening for NCI more feasible. However, additional research is needed with larger samples and normative test performance data are needed.
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Affiliation(s)
- Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute & Columbia University, New York, NY, United States
| | - Hetta Gouse
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | | | - Travis M Scott
- Department of Psychology, Fordham University, Bronx, NY, United States
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute & Columbia University, New York, NY, United States
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute & Columbia University, New York, NY, United States
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute & Columbia University, New York, NY, United States
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Johnson NX, Marquine MJ, Flores I, Umlauf A, Baum CM, Wong AWK, Young AC, Manly JJ, Heinemann AW, Magasi S, Heaton RK. Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc 2017; 23:640-652. [PMID: 28660849 PMCID: PMC5703208 DOI: 10.1017/s1355617717000480] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. METHODS One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. RESULTS An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. CONCLUSIONS We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).
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Affiliation(s)
- Neco X Johnson
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Maria J Marquine
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Ilse Flores
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Anya Umlauf
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Carolyn M Baum
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alex W K Wong
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alexis C Young
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | | | - Allen W Heinemann
- 5Northwestern University,Feinberg School of Medicine,Department of Physical Medicine & Rehabilitation and Rehabilitation Institute of Chicago,Chicago,Illinois
| | - Susan Magasi
- 6University of Illinois at Chicago,Department of Occupational Therapy,Chicago,Illinois
| | - Robert K Heaton
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
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Scott TM, Byrd D, Arce Rentería M, Coulehan K, Miranda C, Fuentes A, Rivera Mindt M. The Combined Roles of Nonsomatic Depressive Symptomatology, Neurocognitive Function, and Current Substance Use in Medication Adherence in Adults Living With HIV Infection. J Assoc Nurses AIDS Care 2017; 29:178-189. [PMID: 28988793 DOI: 10.1016/j.jana.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/10/2017] [Indexed: 01/01/2023]
Abstract
Depression, global neurocognitive (GNC) function, and substance use disorders (SUDs) are each associated with medication adherence in persons living with HIV (PLWH). Because somatic symptoms can inflate depression scores in PLWH, the role of nonsomatic depressive symptomatology (NSDS) should be considered in adherence. However, the combined roles of NSDS, GNC function, and current SUDs in predicting combined antiretroviral therapy (cART) adherence remain poorly understood. Forty PLWH (70% Latina/o; 30% non-Hispanic White) completed psychiatric/SUD, neurocognitive, and self-report cART adherence evaluations. Higher NSDS was associated with suboptimal adherence (p < .01), but optimal and suboptimal adherers did not differ in GNC function or current SUDs. Only NSDS was associated with suboptimal adherence, after accounting for GNC function and SUDs (p = .01). NSDS uniquely predicted self-reported adherence, beyond GNC function and current SUDs among ethnically diverse PLWH. Methodological issues between present and prior studies should also be considered.
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Roles of Medication Responsibility, Executive and Adaptive Functioning in Adherence for Children and Adolescents With Perinatally Acquired HIV. Pediatr Infect Dis J 2017; 36:751-757. [PMID: 28709161 PMCID: PMC5512435 DOI: 10.1097/inf.0000000000001573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medication adherence is a critical but challenging developmental task for children and adolescents with perinatally acquired HIV (PHIV). Understanding how medication responsibility, executive functions (EFs) and adaptive functioning (AF) influence adherence may help prepare adolescents for transition to adulthood. METHODS Participants included PHIV children and adolescents 7-16 years of age enrolled in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol, who were prescribed antiretroviral medications. Measures included caregiver report and child self-report measures of adherence, medication responsibility and EF, caregiver report of child AF, examiner-administered tests of EF and processing speed and demographic and health characteristics. RESULTS Two hundred fifty-six participants with PHIV (mean age: 12 years old) were 51% female, 80% black and 79% non-Hispanic. Per 7-day recall, 72% were adherent (no missed doses). Children/adolescents self-reported that 22% had sole and 55% had shared medication responsibility. Adjusted logistic models revealed significantly higher odds of adherence with sole caregiver responsibility for medication [odds ratio (OR): 4.10, confidence interval (CI): 1.43-11.8, P = 0.009], child nadir CD4% <15% (OR: 2.26, CI: 1.15-4.43, P = 0.018), better self-reported behavioral regulation (OR: 0.65, CI: 0.44-0.96, P = 0.029) and slower processing speed (OR: 0.54, CI: 0.38-0.77, P < 0.001), adjusting for demographic variables (age, race and caregiver education). CONCLUSIONS Among children and adolescents with PHIV, continued caregiver medication management, especially during adolescence, is essential. Although global EF and AF were not significantly associated with adherence, behavioral regulation was. Given that EF and AF develop throughout adolescence, their relationships to adherence should be evaluated longitudinally, especially as youth transition to adulthood and caregiver responsibility diminishes.
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Eggers C, Arendt G, Hahn K, Husstedt IW, Maschke M, Neuen-Jacob E, Obermann M, Rosenkranz T, Schielke E, Straube E. HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment. J Neurol 2017; 264:1715-1727. [PMID: 28567537 PMCID: PMC5533849 DOI: 10.1007/s00415-017-8503-2] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 01/05/2023]
Abstract
The modern antiretroviral treatment of human immunodeficiency virus (HIV-1) infection has considerably lowered the incidence of opportunistic infections. With the exception of the most severe dementia manifestations, the incidence and prevalence of HIV-associated neurocognitive disorders (HAND) have not decreased, and HAND continues to be relevant in daily clinical practice. Now, HAND occurs in earlier stages of HIV infection, and the clinical course differs from that before the widespread use of combination antiretroviral treatment (cART). The predominant clinical feature is a subcortical dementia with deficits in the domains concentration, attention, and memory. Motor signs such as gait disturbance and impaired manual dexterity have become less prominent. Prior to the advent of cART, the cerebral dysfunction could at least partially be explained by the viral load and by virus-associated histopathological findings. In subjects where cART has led to undetectable or at least very low viral load, the pathogenic virus-brain interaction is less direct, and an array of poorly understood immunological and probably toxic phenomena are discussed. This paper gives an overview of the current concepts in the field of HAND and provides suggestions for the diagnostic and therapeutic management.
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Affiliation(s)
- Christian Eggers
- Department of Neurology, Krankenhaus Barmherzige Brüder, Seilerstätte 2, 4021, Linz, Austria.
| | - Gabriele Arendt
- Neurologische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Katrin Hahn
- Neurologische Klinik, Charité, Berlin, Germany
| | - Ingo W Husstedt
- Klinik für Neurologie, Universitätsklinikum Münster, Münster, Germany
| | - Matthias Maschke
- Neurologische Abteilung, Brüderkrankenhaus Trier, Trier, Germany
| | - Eva Neuen-Jacob
- Institut für Neuropathologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Mark Obermann
- Direktor des Zentrums für Neurologie, Asklepios Kliniken Schildautal, Seesen, Germany
| | - Thorsten Rosenkranz
- Neurologische Abteilung, Asklepios-Klinik Hamburg-St. Georg, Hamburg, Germany
| | - Eva Schielke
- Praxis für Neurologie Berlin-Mitte, 10117, Berlin, Germany
| | - Elmar Straube
- HIV-Schwerpunktpraxis, 30890, Barsinghausen, Germany
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Devlin KN, Giovannetti T. Heterogeneity of Neuropsychological Impairment in HIV Infection: Contributions from Mild Cognitive Impairment. Neuropsychol Rev 2017; 27:101-123. [PMID: 28536861 DOI: 10.1007/s11065-017-9348-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 05/02/2017] [Indexed: 02/04/2023]
Abstract
Despite longstanding acknowledgement of the heterogeneity of HIV-associated neurocognitive disorders (HAND), existing HAND diagnostic methods classify according to the degree of impairment, without regard to the pattern of neuropsychological strengths and weaknesses. Research in mild cognitive impairment (MCI) has demonstrated that classifying individuals into subtypes by both their level and pattern of impairment, using either conventional or statistical methods, has etiologic and prognostic utility. Methods for characterizing the heterogeneity of MCI provide a framework that can be applied to other disorders and may be useful in clarifying some of the current challenges in the study of HAND. A small number of studies have applied these methods to examine the heterogeneity of neurocognitive function among individuals with HIV. Most have supported the existence of multiple subtypes of neurocognitive impairment, with some evidence for distinct clinicodemographic features of these subtypes, but a number of gaps exist. Following a review of diagnostic methods and challenges in the study of HAND, we summarize the literature regarding conventional and empirical subtypes of MCI and HAND and identify directions for future research regarding neurocognitive heterogeneity in HIV infection.
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Affiliation(s)
- Kathryn N Devlin
- Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Tania Giovannetti
- Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19122, USA
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Vreeman RC, McCoy BM, Lee S. Mental health challenges among adolescents living with HIV. J Int AIDS Soc 2017; 20:21497. [PMID: 28530045 PMCID: PMC5577712 DOI: 10.7448/ias.20.4.21497] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/14/2017] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Mental health is a critical and neglected global health challenge for adolescents infected with HIV. The prevalence of mental and behavioural health issues among HIV-infected adolescents may not be well understood or addressed as the world scales up HIV prevention and treatment for adolescents. The objective of this narrative review is to assess the current literature related to mental health challenges faced by adolescents living with HIV, including access to mental health services, the role of mental health challenges during transition from paediatric to adult care services and responsibilities, and the impact of mental health interventions. METHODS For each of the topics included in this review, individual searches were run using Medline and PubMed, accompanied by scans of bibliographies of relevant articles. The topics on which searches were conducted for HIV-infected adolescents include depression and anxiety, transition from paediatric to adult HIV care and its impact on adherence and mental health, HIV-related, mental health services and interventions, and the measurement of mental health problems. Articles were included if the focus was consistent with one of the identified topics, involved HIV-infected adolescents, and was published in English. RESULTS AND DISCUSSION Mental and behavioural health challenges are prevalent in HIV-infected adolescents, including in resource-limited settings where most of them live, and they impact all aspects of HIV prevention and treatment. Too little has been done to measure the impact of mental health challenges for adolescents living with HIV, to evaluate interventions to best sustain or improve the mental health of this population, or to create healthcare systems with personnel or resources to promote mental health. CONCLUSIONS Mental health issues should be addressed proactively during adolescence for all HIV-infected youth. In addition, care systems need to pay greater attention to how mental health support is integrated into the care management for HIV, particularly throughout lifespan changes from childhood to adolescence to adulthood. The lack of research and support for mental health needs in resource-limited settings presents an enormous burden for which cost-effective solutions are urgently needed.
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Affiliation(s)
- Rachel C. Vreeman
- Indiana University School Medicine, Department of Pediatrics, Indianapolis, Indiana, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, College of Health Sciences, School of Medicine, Department of Child Health and Paediatrics, Eldoret, Kenya
| | - Brittany M. McCoy
- Indiana University School Medicine, Department of Pediatrics, Indianapolis, Indiana, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonia Lee
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal and Pediatric Infectious Disease Branch, Bethesda, Maryland, USA
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Kamal S, Locatelli I, Wandeler G, Sehhat A, Bugnon O, Metral M, Du Pasquier R, Gutbrod K, Cavassini M, Schneider MP. The Presence of Human Immunodeficiency Virus-Associated Neurocognitive Disorders Is Associated With a Lower Adherence to Combined Antiretroviral Treatment. Open Forum Infect Dis 2017; 4:ofx070. [PMID: 28584853 PMCID: PMC5450901 DOI: 10.1093/ofid/ofx070] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/04/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) are defined according to their diagnostic degrees as follows: asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia. Because high adherence to combined antiretroviral therapy (cART) is required to maintain viral suppression among HIV-infected patients, it is important to investigate the impact of HAND on medication adherence. Our study hypothesis was that patients with HAND had a lower medication adherence than patients who did not have HAND. METHODS This was an observational, exploratory, 2-center pilot study of patients who had a state-of-the-art neurocognitive assessment performed between January 2011 and June 2015 while also being followed at their respective adherence clinics. Adherence was measured with electronic monitors. Patients' sociodemographic characteristics, HIV viral load, and CD4 counts were retrieved from the Swiss HIV Cohort Study database. At each time t, adherence was computed as the proportion of patients taking medication as prescribed at that time. RESULTS We included 59 patients, with a median (Q1, Q3) age of 53 years (47-58) and 39 (66%) were male participants. Twenty-two patients (35%) had no neurocognitive deficits, 16 (27%) patients had HAND, and 21 (35%) patients had non-HAND (mostly depression). Implementation over 3 years showed a significant decline (50%) in medication adherence among patients diagnosed with HAND in comparison with patients who had a normal neuropsychological status or a non-HIV-related cognitive deficit (implementation stayed 90% during follow-up). CONCLUSIONS Our findings support the hypothesis that HAND is associated with reduced cART adherence.
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Affiliation(s)
- Susan Kamal
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Isabella Locatelli
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Department of Social and Preventive Medicine, University of Lausanne, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Asemaneh Sehhat
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | | | | | - Klemens Gutbrod
- Department of Neuropsychology, University Hospital and University of Bern, Switzerland; and
| | - Matthias Cavassini
- Infectious Disease Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Marie P Schneider
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
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Arentsen TJ, Panos S, Thames AD, Arbid JN, Castellon SA, Hinkin CH. Psychosocial Correlates of Medication Adherence among HIV-Positive, Cognitively Impaired Individuals. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2016; 15:404-416. [PMID: 28713226 PMCID: PMC5509354 DOI: 10.1080/15381501.2016.1228309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although cognitive impairment has been shown to adversely affect antiviral medication adherence, a subset of cognitively impaired adults nonetheless are able to adequately adhere to their medication regimen. However, little is known about factors that serve as buffers against suboptimal adherence among the cognitively impaired. This study consisted of 160 HIV-positive, cognitively impaired adults (Global Deficit Score ≥ 0.50) whose medication adherence was monitored over 6-months using an electronic monitoring device (MEMS caps). Logistic regressions were run to determine psychosocial variables associated with medication adherence. Higher self-efficacy and treatment related support, a stable medication regimen, stable stress levels, and absence of current stimulant use were predictive of optimal adherence. A distinct array of psychosocial factors was found that buffer against the adverse effects of cognitive impairment on medication adherence. Assessment and interventions targeting these factors may improve adherence rates among cognitively impaired adults.
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Affiliation(s)
| | - Stella Panos
- VA Greater Los Angeles Healthcare System, Los Angeles CA
- University of California, Los Angeles, Psychiatry and Biobehavioral Sciences, Los Angeles CA
| | - April D. Thames
- University of California, Los Angeles, Psychiatry and Biobehavioral Sciences, Los Angeles CA
| | | | - Steven A. Castellon
- VA Greater Los Angeles Healthcare System, Los Angeles CA
- University of California, Los Angeles, Psychiatry and Biobehavioral Sciences, Los Angeles CA
| | - Charles H. Hinkin
- VA Greater Los Angeles Healthcare System, Los Angeles CA
- University of California, Los Angeles, Psychiatry and Biobehavioral Sciences, Los Angeles CA
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Michałowski JM, Harciarek M, Biedunkiewicz B, Williamson J, Dębska-Ślizień A, Rutkowski B, Heilman KM. Slowing with end-stage renal disease: Attentive but unprepared to act. Int J Psychophysiol 2016; 106:30-8. [DOI: 10.1016/j.ijpsycho.2016.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 11/17/2022]
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Bloch M, Kamminga J, Jayewardene A, Bailey M, Carberry A, Vincent T, Quan D, Maruff P, Brew B, Cysique LA. A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review. Clin Infect Dis 2016; 63:687-693. [PMID: 27325690 DOI: 10.1093/cid/ciw399] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 04/23/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) are not routinely assessed due to the lack of an adequate screening strategy. We aimed to develop a clinically relevant screening procedure for symptomatic HAND, validated against a gold standard neuropsychological (NP) test battery. METHODS Representative HIV-infected (HIV+) and demographically matched HIV-uninfected (HIV-) participants in an observational study completed a standard evaluation for mood, drug and/or alcohol use, and activities of daily living and a newly designed 20-minute computerized CogState battery that assessed 5 cognitive domains. A subset completed standard NP assessment for 8 cognitive domains. HAND definition on screening and gold standard NP was determined using demographically corrected z scores and the global deficit score (≥ 0.5), applying the Frascati criteria. Participants were blinded to screening results, and the NP examiner was blinded to screening and HIV status. RESULTS A total of 254 HIV+ participants were enrolled-mean age, 48.9 ± 10.2 years; median nadir CD4, 270 cells/mL; tertiary educated, 54%; and HIV- controls, 72. HIV+ HAND screening prevalence was 30.7% (HIV-associated dementia, 3.2%; mild neurocognitive disorder, 12.6%; and asymptomatic neurocognitive disorder, 15.0%; HIV- group: 13.9%; P = .004). Of the 75 participants who completed the NP battery, the HAND rate in the HIV+ group was 50.9% vs 43.4% by screening (P > .50). HAND screening vs gold standard NP sensitivity was 76% and specificity was 71%. Clinically relevant HIV-associated dementia and mild neurocognitive disorder sensitivity was 100% and specificity was 98% (positive predictive value 0.92). CONCLUSIONS Symptomatic HAND warranting neurological review was accurately predicted using a CogState-based screening procedure.
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Affiliation(s)
- Mark Bloch
- Holdsworth House Medical Practice.,Faculty of Medicine, University of New South Wales
| | | | - Avindra Jayewardene
- Holdsworth House Medical Practice.,Charles Perkins Centre, University of Sydney, New South Wales
| | | | - Angela Carberry
- Holdsworth House Medical Practice.,Charles Perkins Centre, University of Sydney, New South Wales
| | | | | | - Paul Maruff
- Psychology Department Melbourne University, Victoria
| | - Bruce Brew
- Faculty of Medicine, University of New South Wales.,St Vincent's Hospital.,St Vincent's Applied Medical Research Centre
| | - Lucette A Cysique
- Faculty of Medicine, University of New South Wales.,St Vincent's Hospital.,St Vincent's Applied Medical Research Centre.,Neuroscience Research Australia, Sydney, New South Wales, Australia
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