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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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Ellis RJ, Marquine MJ, Kaul M, Fields JA, Schlachetzki JCM. Mechanisms underlying HIV-associated cognitive impairment and emerging therapies for its management. Nat Rev Neurol 2023; 19:668-687. [PMID: 37816937 PMCID: PMC11052664 DOI: 10.1038/s41582-023-00879-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/12/2023]
Abstract
People living with HIV are affected by the chronic consequences of neurocognitive impairment (NCI) despite antiretroviral therapies that suppress viral replication, improve health and extend life. Furthermore, viral suppression does not eliminate the virus, and remaining infected cells may continue to produce viral proteins that trigger neurodegeneration. Comorbidities such as diabetes mellitus are likely to contribute substantially to CNS injury in people living with HIV, and some components of antiretroviral therapy exert undesirable side effects on the nervous system. No treatment for HIV-associated NCI has been approved by the European Medicines Agency or the US Food and Drug Administration. Historically, roadblocks to developing effective treatments have included a limited understanding of the pathophysiology of HIV-associated NCI and heterogeneity in its clinical manifestations. This heterogeneity might reflect multiple underlying causes that differ among individuals, rather than a single unifying neuropathogenesis. Despite these complexities, accelerating discoveries in HIV neuropathogenesis are yielding potentially druggable targets, including excessive immune activation, metabolic alterations culminating in mitochondrial dysfunction, dysregulation of metal ion homeostasis and lysosomal function, and microbiome alterations. In addition to drug treatments, we also highlight the importance of non-pharmacological interventions. By revisiting mechanisms implicated in NCI and potential interventions addressing these mechanisms, we hope to supply reasons for optimism in people living with HIV affected by NCI and their care providers.
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Affiliation(s)
- Ronald J Ellis
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - María J Marquine
- Department of Medicine, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Marcus Kaul
- School of Medicine, Division of Biomedical Sciences, University of California Riverside, Riverside, CA, USA
| | - Jerel Adam Fields
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Johannes C M Schlachetzki
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
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3
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Franco-Rocha OY, Lewis KA, Longoria KD, De La Torre Schutz A, Wright ML, Kesler SR. Cancer-related cognitive impairment in racial and ethnic minority groups: a scoping review. J Cancer Res Clin Oncol 2023; 149:12561-12587. [PMID: 37432455 DOI: 10.1007/s00432-023-05088-0] [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: 04/19/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Disparities in cognitive function among racial and ethnic groups have been reported in non-cancer conditions, but cancer-related cognitive impairment (CRCI) in racial and ethnic minority groups is poorly understood. We aimed to synthesize and characterize the available literature about CRCI in racial and ethnic minority populations. METHODS We conducted a scoping review in the PubMed, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases. Articles were included if they were published in English or Spanish, reported cognitive functioning in adults diagnosed with cancer, and characterized the race or ethnicity of the participants. Literature reviews, commentaries, letters to the editor, and gray literature were excluded. RESULTS Seventy-four articles met the inclusion criteria, but only 33.8% differentiated the CRCI findings by racial or ethnic subgroups. There were associations between cognitive outcomes and the participants' race or ethnicity. Additionally, some studies found that Black and non-white individuals with cancer were more likely to experience CRCI than their white counterparts. Biological, sociocultural, and instrumentation factors were associated with CRCI differences between racial and ethnic groups. CONCLUSIONS Our findings indicate that racial and ethnic minoritized individuals may be disparately affected by CRCI. Future research should use standardized guidelines for measuring and reporting the self-identified racial and ethnic composition of the sample; differentiate CRCI findings by racial and ethnic subgroups; consider the influence of structural racism in health outcomes; and develop strategies to promote the participation of members of racial and ethnic minority groups.
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Affiliation(s)
- Oscar Y Franco-Rocha
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA.
| | - Kimberly A Lewis
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Kayla D Longoria
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Alexa De La Torre Schutz
- Brain Health Neuroscience Lab, School of Nursing, The University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Michelle L Wright
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
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Xu L, Gill MJ, Power C, Fujiwara E. Verbal Memory Performance and Depressive Symptoms in Persons with Treated HIV. AIDS Behav 2023; 27:2823-2833. [PMID: 36786939 DOI: 10.1007/s10461-023-04006-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
The link between memory and comorbid depression in persons with HIV (PWH) is unclear based on evidence from published cohorts. We compared verbal memory in the HVLT-R in a well-characterized HIV cohort (n = 354) with (n = 102) or without (n = 252) comorbid depressive symptoms, and examined memory correlates in both scenarios. Memory fell within unimpaired ranges, but was lower in depressed than non-depressed PWH. Memory was related to quality of life, sociodemographic, and mental health factors, but not to assessed HIV-related or antiretroviral factors. However, longitudinally (n = 52) memory declined with presence and severity of depressive symptoms. In this treated cohort, verbal memory was unrelated to HIV-related variables but to quality of life and depressive symptoms. Greater performance decline over time also related to acute or ongoing depressive symptoms. These findings highlight the importance of addressing comorbid depressive symptoms to improve quality of life in persons with treated HIV.
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Affiliation(s)
- Lujie Xu
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta HIV Clinic, Alberta Health Services, Calgary, AB, Canada
| | - Christopher Power
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Esther Fujiwara
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.
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Deist M, Suliman S, Kidd M, Franklin D, Cherner M, Heaton RK, Spies G, Seedat S. Neuropsychological Test Norms for the Assessment of HIV-Associated Neurocognitive Impairment Among South African Adults. AIDS Behav 2023; 27:3080-3097. [PMID: 36918465 PMCID: PMC10386947 DOI: 10.1007/s10461-023-04029-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
Reliable and valid neurocognitive (NC) test batteries that assess multiple domains of cognitive functioning are vital tools in the early detection of HIV-associated NC impairment. The HIV Neurobehavioral Research Center's International Neurobehavioral Battery (HNRC Battery) is one such diagnostic tool and has shown cultural validity in several international neuroHIV studies. However, no published norms are currently available for the full HNRC Battery in South Africa. To accurately interpret NC test results, appropriate reference norms are required. In light of this challenge, data were collected from 500 healthy, HIV-uninfected participants to develop demographically corrected South African norms. When demographically corrected United States of America (U.S.) norms were applied to the performance scores of our neurologically intact, HIV-negative sample, an impairment rate of 62.2% was observed compared to a 15.0% impairment rate when the newly generated South African norms were applied. These results reiterate the findings of other low- and middle-income countries, highlighting the need for localized, country-specific norms when interpreting NC performance.
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Affiliation(s)
- Melanie Deist
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Sharain Suliman
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
| | - Donald Franklin
- The HIV Neurobehavioral Research Center (HNRC), San Diego, USA
| | - Mariana Cherner
- The HIV Neurobehavioral Research Center (HNRC), San Diego, USA
| | - Robert K Heaton
- The HIV Neurobehavioral Research Center (HNRC), San Diego, USA
| | - Georgina Spies
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | - Soraya Seedat
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Li H, McLaurin KA, Mactutus CF, Booze RM. Microglia proliferation underlies synaptic dysfunction in the prefrontal cortex: implications for the pathogenesis of HIV-1-associated neurocognitive and affective alterations. J Neurovirol 2023; 29:460-471. [PMID: 37222970 PMCID: PMC10629500 DOI: 10.1007/s13365-023-01147-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023]
Abstract
Microglia, which are productively infected by HIV-1, are critical for brain development and maturation, as well as synaptic plasticity. The pathophysiology of HIV-infected microglia and their role in the pathogenesis of HIV-1-associated neurocognitive and affective alterations, however, remains understudied. Three complementary aims were undertaken to critically address this knowledge gap. First, the expression of HIV-1 mRNA in the dorsolateral prefrontal cortex of postmortem HIV-1 seropositive individuals with HAND was investigated. Utilization of immunostaining and/or RNAscope multiplex fluorescent assays revealed prominent HIV-1 mRNA in microglia of postmortem HIV-1 seropositive individuals with HAND. Second, measures of microglia proliferation and neuronal damage were evaluated in chimeric HIV (EcoHIV) rats. Eight weeks after EcoHIV inoculation, enhanced microglial proliferation was observed in the medial prefrontal cortex (mPFC) of EcoHIV rats, evidenced by an increased number of cells co-localized with both Iba1 + and Ki67 + relative to control animals. Neuronal damage in EcoHIV infected rats was evidenced by pronounced decreases in both synaptophysin and postsynaptic density protein 95 (PSD-95), markers of presynaptic and postsynaptic damage, respectively. Third, regression analyses were conducted to evaluate whether microglia proliferation mechanistically underlies neuronal damage in EcoHIV and control animals. Indeed, microglia proliferation accounted for 42-68.6% of the variance in synaptic dysfunction. Collectively, microglia proliferation induced by chronic HIV-1 viral protein exposure may underlie the profound synaptodendritic alterations in HIV-1. Understanding how microglia are involved in the pathogenesis of HAND and HIV-1-associated affective disorders affords a key target for the development of novel therapeutics.
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Affiliation(s)
- Hailong Li
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Kristen A McLaurin
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Charles F Mactutus
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Rosemarie M Booze
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton Street, Columbia, SC, 29208, USA.
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Li H, McLaurin KA, Mactutus CF, Booze RM. Microglia Proliferation Underlies Synaptic Dysfunction in the Prefrontal Cortex: Implications for the Pathogenesis of HIV-1-Associated Neurocognitive and Affective Alterations. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.20.524942. [PMID: 36711456 PMCID: PMC9882316 DOI: 10.1101/2023.01.20.524942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Microglia, which are productively infected by HIV-1, are critical for brain development and maturation, as well as synaptic plasticity. The pathophysiology of HIV-infected microglia and their role in the pathogenesis of HIV-1-associated neurocognitive and affective alterations, however, remains understudied. Three complementary aims were undertaken to critically address this knowledge gap. First, the predominant cell type expressing HIV-1 mRNA in the dorsolateral prefrontal cortex of postmortem HIV-1 seropositive individuals with HAND was investigated. Utilization of a combined RNAscope multiplex fluorescent and immunostaining assay revealed prominent HIV-1 mRNA in microglia of postmortem HIV-1 seropositive individuals with HAND. Second, measures of microglia proliferation and neuronal damage were evaluated in chimeric HIV (EcoHIV) rats. Eight weeks after EcoHIV innoculation, enhanced microglial proliferation was observed in the medial prefrontal cortex (mPFC) of EcoHIV rats, evidenced by an increased number of cells co-localized with both Iba1+ and Ki67+ relative to control animals. Neuronal damage in EcoHIV infected rats was evidenced by pronounced decreases in both synaptophysin and post synaptic density protein 95 (PSD-95), markers of pre-synaptic and post-synaptic damage, respectively. Third, regression analyses were conducted to evaluate whether microglia proliferation mechanistically underlies neuronal damage in EcoHIV and control animals. Indeed, microglia proliferation accounts for 42-68.6% of the variance in synaptic dysfunction. Collectively, microglia proliferation induced by chronic HIV-1 viral protein exposure may underlie the profound synaptodendritic alterations in HIV-1. Understanding how microglia are involved in the pathogenesis of HAND and HIV-1-associated affective disorders affords a key target for the development of novel therapeutics.
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Byrnes SJ, Angelovich TA, Busman-Sahay K, Cochrane CR, Roche M, Estes JD, Churchill MJ. Non-Human Primate Models of HIV Brain Infection and Cognitive Disorders. Viruses 2022; 14:v14091997. [PMID: 36146803 PMCID: PMC9500831 DOI: 10.3390/v14091997] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Human Immunodeficiency virus (HIV)-associated neurocognitive disorders are a major burden for people living with HIV whose viremia is stably suppressed with antiretroviral therapy. The pathogenesis of disease is likely multifaceted, with contributions from viral reservoirs including the brain, chronic and systemic inflammation, and traditional risk factors including drug use. Elucidating the effects of each element on disease pathogenesis is near impossible in human clinical or ex vivo studies, facilitating the need for robust and accurate non-human primate models. In this review, we describe the major non-human primate models of neuroHIV infection, their use to study the acute, chronic, and virally suppressed infection of the brain, and novel therapies targeting brain reservoirs and inflammation.
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Affiliation(s)
- Sarah J. Byrnes
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Thomas A. Angelovich
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC 3000, Australia
- Life Sciences, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Kathleen Busman-Sahay
- Vaccine and Gene Therapy Institute, Oregon Health & Science University, Portland, OR 97006, USA
| | - Catherine R. Cochrane
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Michael Roche
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC 3000, Australia
| | - Jacob D. Estes
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
- Vaccine and Gene Therapy Institute, Oregon Health & Science University, Portland, OR 97006, USA
- Oregon National Primate Research Centre, Oregon Health & Science University, Portland, OR 97006, USA
| | - Melissa J. Churchill
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
- Life Sciences, Burnet Institute, Melbourne, VIC 3004, Australia
- Departments of Microbiology and Medicine, Monash University, Clayton, VIC 3800, Australia
- Correspondence:
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Impact of HIV-associated cognitive impairment on functional independence, frailty and quality of life in the modern era: a meta-analysis. Sci Rep 2022; 12:6470. [PMID: 35440802 PMCID: PMC9019017 DOI: 10.1038/s41598-022-10474-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
HIV-associated neurocognitive disorder (HAND) is an important sequela of HIV infection. Combined antiretroviral therapy (cART) has improved the health outcomes of many people living with HIV but has given rise to a less severe but limiting form of HAND. The study aimed to evaluate the impact of HAND on medication adherence, activities of daily living (ADL), quality of life and frailty. This systematic review adheres to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched MEDLINE, PubMed, CINAHL, Academic Search Complete, and PsycINFO online databases. Studies were included if they examined the relationship between HAND and medication adherence, ADL, quality of life and frailty, and were conducted between 1997 and 2021. We used a random-effects meta-analysis model to assess the impact of HAND on outcome variables. Forty papers, totaling 11,540 participants, were included in the narrative and quantitative syntheses. Cognitive impairment was associated with poorer medication adherence (r = 0.601, CI 0.338 to 0.776, p = 0.001, I2 = 94.66). Cognitive impairment did not influence ADL (r = 0.167, CI-0.215 to 0.505, p = 0.393) and quality of life (r = 0.244, CI 0.117 to 0.548, p = 0.182). In the cART era, HAND appears to be associated with adherence to medication, which may influence future health outcomes. In PLWHIV who are adherent to cART, cognitive impairment does not appear to interfere with ADL and quality of life.
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Abstract
OBJECTIVES In the neuroHIV literature, cognitive reserve has most often been operationalized using education, occupation, and IQ. The effects of other cognitively stimulating activities that might be more amenable to interventions have been little studied. The purpose of this study was to develop an index of cognitive reserve in people with HIV, combining multiple indicators of cognitively stimulating lifetime experiences into a single value. METHODS The data set was obtained from a Canadian longitudinal study (N = 856). Potential indicators of cognitive reserve captured at the study entry included education, occupation, engagement in six cognitively stimulating activities, number of languages spoken, and social resources. Cognitive performance was measured using a computerized test battery. A cognitive reserve index was formulated using logistic regression weights. For the evidence on concurrent and predictive validity of the index, the measures of cognition and self-reported everyday functioning were each regressed on the index scores at study entry and at the last follow-up [mean duration: 25.9 months (SD 7.2)], respectively. Corresponding regression coefficients and 95% confidence intervals (CIs) were computed. RESULTS Professional sports [odds ratio (OR): 2.9; 95% CI 0.59-14.7], visual and performance arts (any level of engagement), professional/amateur music, complex video gaming and competitive games, and travel outside North America were associated with higher cognitive functioning. The effects of cognitive reserve on the outcomes at the last follow-up visit were closely similar to those at study entry. CONCLUSION This work contributes evidence toward the relative benefit of engaging in specific cognitively stimulating life experiences in HIV.
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Lahimgarzadeh R, Vaseghi S, Nasehi M, Rouhollah F. Effect of multi-epitope derived from HIV-1 on REM sleep deprivation-induced spatial memory impairment with respect to the level of immune factors in mice. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2022; 25:164-172. [PMID: 35655593 PMCID: PMC9124535 DOI: 10.22038/ijbms.2022.61175.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/19/2022] [Indexed: 11/08/2022]
Abstract
Objectives Sleep deprivation (SD) has a negative impact on cognitive functions including learning and memory. Many studies have shown that rapid-eye-movement (REM) SD also disrupts memory performance. In this study, we aimed to investigate the effect of multi-epitope Gag-Pol-Env-Tat derived from Human immunodeficiency virus 1 (HIV-1) on REM SD-induced spatial memory impairment with respect to the levels of interleukin-4 (IL-4), interleukin-17 (IL-17), interferon-gamma (IFN-γ), immunoglobulin G1 (IgG1), immunoglobulin G2a (IgG2a), and lymphocyte proliferation in NMRI mice. We used multi-epitope Gag-Pol-Env-Tat derived from HIV-1 because Gag-Pol-Env-Tat immunogen sequence is one of the most sensitive immunogen sequences of HIV-1 that can significantly augment cellular and humoral immune systems, leading to the improvement of cognitive functions. Materials and Methods Morris water maze apparatus was used to assess spatial memory, and multi-platform apparatus was used to induce RSD for 24 hr. Multi-epitope derived from HIV-1 was subcutaneously injected at the dose of 20 µgr/ml, once and fourteen days before RSD. Results RSD impaired spatial memory and injection of multi-epitope derived from HIV-1 reversed this effect. RSD decreased IL-4, IgG1, and IgG2a levels, while multi-epitope derived from HIV-1 reversed these effects. Multi-epitope derived from HIV-1 also increased lymphocyte proliferation and decreased IL-17 levels in both control and RSD mice. Conclusion Multi-epitope derived from HIV-1 may improve memory performance via induction of anti-inflammatory immune response.
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Affiliation(s)
- Roya Lahimgarzadeh
- Department of Cellular and Molecular Biology, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Salar Vaseghi
- Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran
| | - Mohammad Nasehi
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Tehran, Iran ,Cognitive and Neuroscience Research Center (CNRC), Amir-Almomenin Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Fatemeh Rouhollah
- Department of Cellular and Molecular Biology, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran ,Corresponding author: Fatemeh Rouhollah. Department of Cellular and Molecular Biology, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran. Tel: +98-21-66402569; Fax: +98-21-66402569;
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Fernandez Cruz AL, Chen CM, Sanford R, Collins DL, Brouillette MJ, Mayo NE, Fellows LK. Multimodal neuroimaging markers of variation in cognitive ability in older HIV+ men. PLoS One 2021; 16:e0243670. [PMID: 34314416 PMCID: PMC8315526 DOI: 10.1371/journal.pone.0243670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/12/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE This study used converging methods to examine the neural substrates of cognitive ability in middle-aged and older men with well-controlled HIV infection. METHODS Seventy-six HIV+ men on antiretroviral treatment completed an auditory oddball task and an inhibitory control (Simon) task while time-locked high-density EEG was acquired; 66 had usable EEG data from one or both tasks; structural MRI was available for 43. We investigated relationships between task-evoked EEG responses, cognitive ability and immunocompromise. We also explored the structural correlates of these EEG markers in the sub-sample with complete EEG and MRI data (N = 27). RESULTS EEG activity was associated with cognitive ability at later (P300) but not earlier stages of both tasks. Only the oddball task P300 was reliably associated with HIV severity (nadir CD4). Source localization confirmed that the tasks engaged partially distinct circuits. Thalamus volume correlated with oddball task P300 amplitude, while globus pallidus volume was related to the P300 in both tasks. INTERPRETATION This is the first study to use task-evoked EEG to identify neural correlates of individual differences in cognition in men living with well-controlled HIV infection, and to explore the structural basis of the EEG markers. We found that EEG responses evoked by the oddball task are more reliably related to cognitive performance than those evoked by the Simon task. We also provide preliminary evidence for a subcortical contribution to the effects of HIV infection severity on P300 amplitudes. These results suggest brain mechanisms and candidate biomarkers for individual differences in cognition in HIV.
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Affiliation(s)
- Ana Lucia Fernandez Cruz
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Chien-Ming Chen
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ryan Sanford
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - D. Louis Collins
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Nancy E. Mayo
- School of Physical and Occupational Therapy, Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lesley K. Fellows
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Babicz MA, Woods SP, Matchanova A, Medina LD, Podell K, Walker RL, Fetterman A, Rahman S, Johnson B, Thompson JL, Sullivan KL, Beltran-Najera I, Brooks J, Morales Y, Avci G. How did individual differences in neurocognition and health literacy influence the initial uptake and use of health-related information about COVID-19? J Clin Exp Neuropsychol 2021; 43:497-513. [PMID: 34142928 DOI: 10.1080/13803395.2021.1937579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The rapid development of coronavirus disease 2019 (COVID-19) into a pandemic required people to quickly acquire, evaluate, and apply novel complex health-related information about the virus and transmission risks. This study examined the potentially unique and synergistic roles of individual differences in neurocognition and health literacy in the early uptake and use of COVID-19 public health information.Method: Data were collected between April 23 and 21 May 2020, a period during which 42 out of 50 states were under a stay-at-home order. Participants were 217 healthy adults who completed a telephone-based battery that included standard tests of neurocognition, health literacy, verbal IQ, personality, and anxiety. Participants also completed measures of COVID-19 information-seeking skills, knowledge, prevention intentions, and prevention behaviors.Results: A series of hierarchical multiple regressions with data-driven covariates showed that neurocognition (viz, episodic verbal memory and executive functions) was independently related to COVID-19 knowledge (e.g. symptoms, risks) at a medium effect size, but not to information-seeking skills, prevention intentions, or prevention behaviors. Health literacy was independently related to all measured aspects of COVID-19 health information and did not interact with neurocognition in any COVID-19 health domain.Conclusions: Individual differences in neurocognition and health literacy played independent and meaningful roles in the initial acquisition of knowledge related to COVID-19, which is a novel human health condition. Future studies might examine whether neurocognitive supports (e.g. spaced retrieval practice, elaboration) can improve COVID-19-related knowledge and health behaviors in vulnerable populations.
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Affiliation(s)
| | | | | | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Kenneth Podell
- Department of Neurology, Methodist Hospital, Indianapolis, IN, USA
| | - Rheeda L Walker
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Adam Fetterman
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Samina Rahman
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Briana Johnson
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Kelli L Sullivan
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Jasmin Brooks
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Yenifer Morales
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Gunes Avci
- Department of Psychology, University of Houston, Houston, TX, USA
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14
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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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15
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Mahboobi M, Najafi A, Nakhostin-Ansari A, Kazerooni PA, Bazargani M, Navaiian F, Akbarpour S. Depression, sleep quality and condom use amongst Iranian people living with human immunodeficiency virus. South Afr J HIV Med 2021; 21:1150. [PMID: 33391831 PMCID: PMC7756672 DOI: 10.4102/sajhivmed.v21i1.1150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background Depression is a common mood disorder in people living with human immunodeficiency virus (PLWH) and is associated with risk-taking sexual behaviour. Objectives This study examines depression, sleep quality and condom usage amongst PLWH in Tehran, Iran. Method This cross-sectional study was undertaken between October and November 2019 on 298 PLWH referred to voluntary counselling and testing centres (VCTs) in Tehran. Participants provided information as per the following questionnaires: the Depression, Anxiety, Stress Scale (DASS), the Pittsburgh Sleep Quality Index Questionnaire and a demographic questionnaire that evaluated condom use. Results A total of 298 PLWH, of whom 202 (67.8%) were men with a mean age of 39.81 years, were enrolled in the study. The DASS classified 57% with depression. Fewer than 20% of these used condoms regularly. The majority of depressed patients were men (68.6%) and 31.4% were women. The depressed patients were more likely not to use condoms than those who were not depressed (adjusted odds ratio [OR] = 6.5; 95% confidence interval [CI], 3.70–11.42). The adjusted OR for not using a condom amongst the depressed was 7.12 times greater (95% CI, 5.85–10.11) than in those without depression. Conclusion Our findings suggest that depression is common amongst PLWH in Tehran and is associated with risk-taking sexual behaviour. Appropriate interventions are needed to address mental disorders in PLWH. It is recommended that patients be screened regularly for symptoms of depression and, where indicated, counselled and managed.
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Affiliation(s)
- Marzieh Mahboobi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arezu Najafi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Afsar Kazerooni
- Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Matin Bazargani
- HIV Expert of Deputy of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Navaiian
- HIV Expert of Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
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16
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Cumulative Burden of Depression and Neurocognitive Decline Among Persons With HIV: A Longitudinal Study. J Acquir Immune Defic Syndr 2021; 84:304-312. [PMID: 32195746 DOI: 10.1097/qai.0000000000002346] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Higher cumulative burden of depression among people with HIV (PWH) is associated with poorer health outcomes; however, longitudinal relationships with neurocognition are unclear. This study examined hypotheses that among PWH, (1) higher cumulative burden of depression would relate to steeper declines in neurocognition, and (2) visit-to-visit depression severity would relate to fluctuations in neurocognition within persons. SETTING Data were collected at a university-based research center from 2002 to 2016. METHODS Participants included 448 PWH followed longitudinally. All participants had >1 visit (M = 4.97; SD = 3.53) capturing depression severity (Beck Depression Inventory-II) and neurocognition (comprehensive test battery). Cumulative burden of depression was calculated using an established method that derives weighted depression severity scores by time between visits and total time on study. Participants were categorized into low (67%), medium (15%), and high (18%) depression burden. Multilevel modeling examined between- and within-person associations between cumulative depression burden and neurocognition over time. RESULTS The high depression burden group demonstrated steeper global neurocognitive decline compared with the low depression burden group (b = -0.100, P = 0.001); this was driven by declines in executive functioning, delayed recall, and verbal fluency. Within-person results showed that compared with visits when participants reported minimal depressive symptoms, their neurocognition was worse when they reported mild (b = -0.12, P = 0.04) or moderate-to-severe (b = -0.15, P = 0.03) symptoms; this was driven by worsened motor skills and processing speed. CONCLUSIONS High cumulative burden of depression is associated with worsening neurocognition among PWH, which may relate to poor HIV-related treatment outcomes. Intensive interventions among severely depressed PWH may benefit physical, mental, and cognitive health.
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17
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Nickoloff-Bybel EA, Calderon TM, Gaskill PJ, Berman JW. HIV Neuropathogenesis in the Presence of a Disrupted Dopamine System. J Neuroimmune Pharmacol 2020; 15:729-742. [PMID: 32506353 PMCID: PMC7905900 DOI: 10.1007/s11481-020-09927-6] [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] [Received: 10/28/2019] [Accepted: 05/26/2020] [Indexed: 12/23/2022]
Abstract
Antiretroviral therapy (ART) has transformed HIV into a chronic condition, lengthening and improving the lives of individuals living with this virus. Despite successful suppression of HIV replication, people living with HIV (PLWH) are susceptible to a growing number of comorbidities, including neuroHIV that results from infection of the central nervous system (CNS). Alterations in the dopaminergic system have long been associated with HIV infection of the CNS. Studies indicate that changes in dopamine concentrations not only alter neurotransmission, but also significantly impact the function of immune cells, contributing to neuroinflammation and neuronal dysfunction. Monocytes/macrophages, which are a major target for HIV in the CNS, are responsive to dopamine. Therefore, defining more precisely the mechanisms by which dopamine acts on these cells, and the changes in cellular function elicited by this neurotransmitter are necessary to develop therapeutic strategies to treat neuroHIV. This is especially important for vulnerable populations of PLWH with chemically altered dopamine concentrations, such as individuals with substance use disorder (SUD), or aging individuals using dopamine-altering medications. The specific neuropathologic and neurocognitive consequences of increased CNS dopamine remain unclear. This is due to the complex nature of HIV neuropathogenesis, and logistical and technical challenges that contribute to inconsistencies among cohort studies, animal models and in vitro studies, as well as lack of demographic data and access to human CNS samples and cells. This review summarizes current understanding of the impact of dopamine on HIV neuropathogenesis, and proposes new experimental approaches to examine the role of dopamine in CNS HIV infection. Graphical abstract HIV Neuropathogenesis in the Presence of a Disrupted Dopamine System. Both substance abuse disorders and the use of dopaminergic medications for age-related diseases are associated with changes in CNS dopamine concentrations and dopaminergic neurotransmission. These changes can lead to aberrant immune function, particularly in myeloid cells, which contributes to the neuroinflammation, neuropathology and dysfunctional neurotransmission observed in dopamine-rich regions in HIV+ individuals. These changes, which are seen despite the use antiretroviral therapy (ART), in turn lead to further dysregulation of the dopamine system. Thus, in individuals with elevated dopamine, the bi-directional interaction between aberrant dopaminergic neurotransmission and HIV infection creates a feedback loop contributing to HIV associated neurocognitive dysfunction and neuroHIV. However, the distinct contributions and interactions made by HIV infection, inflammatory mediators, ART, drugs of abuse, and age-related therapeutics are poorly understood. Defining more precisely the mechanisms by which these factors influence the development of neurological disease is critical to addressing the continued presence of neuroHIV in vulnerable populations, such as HIV-infected older adults or drug abusers. Due to the complexity of this system, understanding these effects will require a combination of novel experimental modalities in the context of ART. These will include more rigorous epidemiological studies, relevant animal models, and in vitro cellular and molecular mechanistic analysis.
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Affiliation(s)
- E A Nickoloff-Bybel
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, 19102, USA
| | - T M Calderon
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - P J Gaskill
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, 19102, USA.
| | - J W Berman
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
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18
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Fazeli PL, Woods SP, Lambert CC, Waldrop-Valverde D, Vance DE. Neurocognitive Functioning is Associated with Self-Reported and Performance-Based Treatment Management Abilities in People Living with HIV with Low Health Literacy. Arch Clin Neuropsychol 2020; 35:517-527. [PMID: 32090235 DOI: 10.1093/arclin/acaa005] [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] [Received: 10/14/2019] [Revised: 11/27/2019] [Accepted: 01/13/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE People living with HIV (PLWH) are at higher risk for poorer neurocognitive functioning and health literacy than uninfected persons, which are associated with worse medical outcomes. Aging research suggests that the effect of neurocognitive functioning on health outcomes may be more pronounced in those with low health literacy. We aimed to determine whether low health literacy might amplify the adverse effects of neurocognitive functioning on treatment management outcomes in 171 PLWH aged 40+. METHOD In this cross-sectional, observational study, participants completed a well-validated battery of neurocognitive, health literacy, and treatment management measures. A binary health literacy variable (low vs. adequate) was determined via established cut points on the well-validated health literacy tests. Treatment management outcomes included biomarkers of HIV (i.e., CD4 counts and viral load), self-management of HIV disease (i.e., self-reported medication adherence and self-efficacy for HIV disease management), and performance-based health-related decision-making. RESULTS Forty-seven percent of the sample met the criteria for low health literacy. Multivariable regressions adjusting for clinicodemographic (e.g., race, socioeconomic status) covariates revealed significant interactions for self-efficacy for HIV disease management and health-related decision-making, such that neurocognitive functioning was associated with these outcomes among those with low, but not adequate health literacy. CONCLUSIONS Findings suggest that low health literacy may increase the vulnerability of PLWH to the adverse effects of neurocognitive impairment on health outcomes, or conversely that adequate health literacy may provide a buffer against the health risks associated neurocognitive impairment. Interventions targeting health literacy in PLWH may mitigate the effects of neurocognitive impairment on health outcomes.
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Affiliation(s)
- Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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19
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van Genderen JG, Van den Hof M, Boyd AC, Caan MWA, Wit FWNM, Reiss P, Pajkrt D. Differences in location of cerebral white matter hyperintensities in children and adults living with a treated HIV infection: A retrospective cohort comparison. PLoS One 2020; 15:e0241438. [PMID: 33112914 PMCID: PMC7592958 DOI: 10.1371/journal.pone.0241438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
Cerebral white matter hyperintensities (WMH) persist in children and adults living with HIV, despite effective combination antiretroviral therapy (cART). As age and principal routes of transmission differ between children (perinatally) and adults (behaviorally), comparing the characteristics and determinants of WMH between these populations may increase our understanding of the pathophysiology of WMH. From separate cohorts of 31 children (NOVICE) and 74 adults (AGEhIV), we cross-sectionally assessed total WMH volume and number of WMH per location (periventricular vs. deep) using fluid-attenuated inversion recovery (FLAIR) MRI images. WMH were either periventricular when within 10mm of the lateral ventricles, or deep otherwise. We assessed patient- or HIV-related determinants of total WMH volume (adjusted for intracranial volume) and location of WMH using logistic regression, while stratifying on children and adults. At enrollment, median age of participants was 13.8 years (IQR 11.4-15.9) for children and 53.4 years (IQR 48.3-60.8) for adults and 27/31 children (87%) and 74/74 adults (100%) had an HIV RNA viral load <200 copies/mL. WMH were present in 16/27 (52%) children and 74/74 adults (100%). The prevalence of deep WMH was not different between groups, (16/16 [100%] in children vs. 71/74 [96%] in adults, p = 0,999), yet periventricular WMH were more prevalent in adults (74/74 [100%]) compared to children (9/16; 56%) (p<0.001). Median WMH volume was higher in adults compared to children (1182 mm3 [425-2617] vs. 109 mm3 [61.7-625], p<0.001). In children, boys were more likely to have deep WMH compared to girls. In adults, older age was associated with higher total WMH volume, and age, hypertension and lower CD4+ T-lymphocyte nadir with a higher number of periventricular WMH. Our findings suggest that the location of WMH differs between children and adults living with HIV, hinting at a different underlying pathogenesis.
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Affiliation(s)
- Jason G. van Genderen
- Department of Pediatric Infectious Diseases, Emma Children’s Hospital,
Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands
| | - Malon Van den Hof
- Department of Pediatric Infectious Diseases, Emma Children’s Hospital,
Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands
| | - Anders C. Boyd
- HIV Monitoring Foundation, Amsterdam, The Netherlands
- Public Health Service of Amsterdam, Department of Infectious Diseases,
Amsterdam, The Netherlands
| | - Matthan W. A. Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC,
University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Ferdinand W. N. M. Wit
- HIV Monitoring Foundation, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam,
The Netherlands
- Department of Global Health, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Peter Reiss
- HIV Monitoring Foundation, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam,
The Netherlands
- Department of Global Health, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Emma Children’s Hospital,
Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands
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20
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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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21
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Decreases in Self-Reported ART Adherence Predict HIV Viremia Among Pregnant and Postpartum South African Women. J Acquir Immune Defic Syndr 2019; 80:247-254. [PMID: 30422906 DOI: 10.1097/qai.0000000000001909] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Routine HIV viral load (VL) monitoring is recommended for patients on antiretroviral therapy, but frequent VL testing, required in pregnant and postpartum women, is often not feasible. Self-reported adherence can be valuable, but little is known about its longitudinal characteristics. METHODS We followed women living with HIV from antiretroviral therapy initiation in pregnancy through 18-month postpartum in Cape Town, South Africa, with repeated measurement of VL and self-reported adherence using a 3-item scale. We used generalized estimating equations [with results presented as odds ratios (ORs) with 95% confidence intervals (CIs)] to investigate the association between viremia and change in adherence over pairs of consecutive visits. RESULTS Among 2085 visit pairs from 433 women, a decrease in self-reported adherence relative to the previous visit on any of the 3 self-report items, or the combined scale, was associated with VL >50 and >1000 copies per milliliter. The best-performing thresholds to predict VL >50 copies per milliliter were a single-level decrease on the Likert response item "how good a job did you do at taking your HIV medicines in the way that you were supposed to?" (OR 2.08, 95% CI: 1.48 to 2.91), and a decrease equivalent to ≥5 missed doses or a one-level decrease in score on either of 2 Likert items (OR 1.34, 95% CI: 1.06 to 1.69). CONCLUSIONS Longitudinal changes in self-reported adherence can help identify patients with viremia. This approach warrants consideration in settings where frequent VL monitoring or other objective adherence measures are not possible.
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22
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Hshieh TT, Jung WF, Grande LJ, Chen J, Stone RM, Soiffer RJ, Driver JA, Abel GA. Prevalence of Cognitive Impairment and Association With Survival Among Older Patients With Hematologic Cancers. JAMA Oncol 2019; 4:686-693. [PMID: 29494732 DOI: 10.1001/jamaoncol.2017.5674] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance As the population ages, cognitive impairment has promised to become increasingly common among patients with cancer. Little is known about how specific domains of cognitive impairment may be associated with survival among older patients with hematologic cancers. Objective To determine the prevalence of domain-specific cognitive impairment and its association with overall survival among older patients with blood cancer. Design, Setting, and Participants This prospective observational cohort study included all patients 75 years and older who presented for initial consultation in the leukemia, myeloma, or lymphoma clinics of a large tertiary hospital in Boston, Massachusetts, from February 1, 2015, to March 31, 2017. Patients underwent screening for frailty and cognitive dysfunction and were followed up for survival. Exposures The Clock-in-the-Box (CIB) test was used to screen for executive dysfunction. A 5-word delayed recall test was used to screen for impairment in working memory. The Fried frailty phenotype and Rockwood cumulative deficit model of frailty were also assessed to characterize participants as robust, prefrail, or frail. Results Among 420 consecutive patients approached, 360 (85.7%) agreed to undergo frailty assessment (232 men [64.4%] and 128 women [35.6%]; mean [SD] age, 79.8 [3.9] years), and 341 of those (94.7%) completed both cognitive screening tests. One hundred twenty-seven patients (35.3%) had probable executive dysfunction on the CIB, and 62 (17.2%) had probable impairment in working memory on the 5-word delayed recall. Impairment in either domain was modestly correlated with the Fried frailty phenotype (CIB, ρ = 0.177; delayed recall, ρ = 0.170; P = .01 for both), and many phenotypically robust patients also had probable cognitive impairment (24 of 104 [23.1%] on CIB and 9 of 104 [8.7%] on delayed recall). Patients with impaired working memory had worse median survival (10.9 [SD, 12.9] vs 12.2 [SD, 14.7] months; log-rank P < .001), including when stratified by indolent cancer (log-rank P = .01) and aggressive cancer (P < .001) and in multivariate analysis when adjusting for age, comorbidities, and disease aggressiveness (odds ratio, 0.26; 95% CI, 0.13-0.50). Impaired working memory was also associated with worse survival for those undergoing intensive treatment (log-rank P < .001). Executive dysfunction was associated with worse survival only among patients who underwent intensive treatment (log-rank P = .03). Conclusions and Relevance These data suggest that domains of cognitive dysfunction may be prevalent in older patients with blood cancer and may have differential predictive value for survival. Targeted interventions are needed for this vulnerable patient population.
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Affiliation(s)
- Tammy T Hshieh
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Wooram F Jung
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Laura J Grande
- Psychology Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Jiaying Chen
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert J Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jane A Driver
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Gregory A Abel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Determinants of cognitive health in Indonesian HIV patients beginning antiretroviral therapy. J Neurovirol 2019; 26:32-40. [PMID: 31385196 DOI: 10.1007/s13365-019-00787-2] [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] [Received: 03/20/2018] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
Cognitive impairment has been described in people living with HIV and stable on antiretroviral therapy (ART), but has not been monitored in young adults beginning ART with a high burden of cytomegalovirus. We recruited 80 subjects beginning ART with < 200 CD4 T cells/μL in Jakarta, Indonesia. Cognitive function (Z-scores) began low but improved on ART, stabilizing after 6 months with improvements in all domains except memory function. The burden of cytomegalovirus persisting on ART (assessed via antibody levels) correlated inversely with Z-scores (notably memory function) at baseline. In linear mixed models, improvements in Z-scores were influenced by age, education, and CD4 T cell counts.
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Carvalho PP, Barroso SM, Coelho HC, Penaforte FRDO. Factors associated with antiretroviral therapy adherence in adults: an integrative review of literature. CIENCIA & SAUDE COLETIVA 2019; 24:2543-2555. [PMID: 31340272 DOI: 10.1590/1413-81232018247.22312017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/19/2017] [Indexed: 12/29/2022] Open
Abstract
AIDS is an advanced clinical manifestation of HIV infection. It generates severe immunodeficiency and associated infections that may lead to death. The antiretroviral therapy (ART) has reduced the morbimortality of HIV/AIDS, but its benefits depend on ART adherence. This integrative review followed the PICO method to identify factors associated with adult adherence to ART. Empirical papers published between January 2010 and December 2016 in the Medline, SciELO, Lilacs and PePSIC databases were included. We analyzed 125 papers regarding the characteristics of studies, adherence measures and associated factors. Results showed a wide variety in the definition of adherence and the use of measures for its monitoring, as well as several adherence-associated factors. These were categorized as follows: 1- Individual variables; 2- Treatment characteristics; 3- HIV/aids infection characteristics; 4- Relationship with the health services; 5- Social support. Health services should characterize the users' profiles, systematize adherence measures and regionally assess adherence-associated factors for the early detection of non-adherence to ART and implementation of effective intervention plans.
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Affiliation(s)
- Patrícia Paiva Carvalho
- Hospital de Clínicas, Universidade Federal do Triângulo Mineiro (UFTM). Av. Getúlio Guaritá 130, Nossa Sra. da Abadia. 38025-440 Uberaba MG Brasil.
| | | | - Heloisa Correa Coelho
- Hospital de Clínicas, Universidade Federal do Triângulo Mineiro (UFTM). Av. Getúlio Guaritá 130, Nossa Sra. da Abadia. 38025-440 Uberaba MG Brasil.
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Shrestha R, Altice FL, Sibilio B, Ssenyonjo J, Copenhaver MM. Rationale and design of an integrated bio-behavioral approach to improve adherence to pre-exposure prophylaxis and HIV risk reduction among opioid-dependent people who use drugs: The CHRP-BB study. Contemp Clin Trials 2019; 82:77-84. [PMID: 31229618 PMCID: PMC6639056 DOI: 10.1016/j.cct.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/09/2019] [Accepted: 06/19/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Few primary HIV prevention strategies have successfully integrated both behavioral and biomedical components, with modest HIV risk reduction outcomes among opioid-dependent people who use drugs (PWUD). In response to this unmet need, we developed a brief, bio-behavioral intervention to simultaneously promote PrEP adherence and reduce HIV risk among opioid-dependent PWUD. METHODS Using a Hybrid Type I implementation science design, we will examine the efficacy of the integrated bio-behavioral, Community-friendly Health Recovery Program (CHRP-BB) compared to a time-and-attention matched control condition among HIV-negative, opioid-dependent PWUD who are prescribed PrEP and enrolled in a methadone maintenance program (MMP) using a randomized controlled trial (RCT). Participants are assessed at baseline, immediately post-intervention (8 weeks) and follow-ups at weeks 20, 32, and 44 post-intervention. The primary outcome is biomedical (PrEP adherence), with secondary outcomes including behavioral (self-reported drug- and sex-related HIV risk behaviors), ongoing drug use (confirmed with urine drug testing), and related domains of the theoretical information-motivation-behavioral skills (IMB) model of behavior change related to PrEP adherence and HIV-transmission-risk reduction. Additionally, we will conduct a process evaluation of delivery/implementation of the intervention to collect valuable information to be used in future implementation. CONCLUSIONS This study will be among the first prospective trial to test an integrated bio-behavioral intervention to improve adherence to PrEP and HIV risk reduction among opioid-dependent PWUD.
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Affiliation(s)
- Roman Shrestha
- Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA.
| | - Frederick L Altice
- Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA; Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, USA
| | - Brian Sibilio
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Jude Ssenyonjo
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Michael M Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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Quigley A, O'Brien KK, Brouillette MJ, MacKay-Lyons M. Evaluating the Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes in People Living With HIV: Protocol for a Randomized Pilot Trial. JMIR Res Protoc 2019; 8:e13818. [PMID: 31115343 PMCID: PMC6547772 DOI: 10.2196/13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Despite lower mortality rates due to combination antiretroviral therapy, people living with HIV (PLWH) are grappling with increasingly complex health issues, including cognitive impairments in areas such as memory, attention, processing speed, and motor function. Yoga has been shown to be an effective form of exercise and mindfulness-based stress reduction for many clinical populations. However, no randomized trials have evaluated the impact of yoga on cognitive and physical function among PLWH. Objective The aim of this pilot randomized trial was to determine the feasibility of a yoga intervention to lay the groundwork for a full-scale, multisite, community-based trial for PLWH. Specific objectives are to (1) assess the feasibility of study protocol and procedures, (2) compare cognition in the yoga group with the usual care control group after 12 weeks of the intervention in PLWH, and (3) compare the effects of the 12-week yoga intervention versus control on balance, walking speed, physical activity, mental health, medication adherence, and quality of life among PLWH. Methods We propose a pilot randomized trial with 2 parallel groups (yoga versus control). We will recruit 25 PLWH (>35 years) from community and health organizations in Halifax, Canada. After baseline assessment with blinded assessors, participants will be randomly assigned to the yoga or control group, using a random computer generator. Participants in the yoga group will engage in supervised 60-min group-based yoga sessions 3 times a week for 12 weeks at a yoga studio. Participants in the control group will maintain their current physical activity levels throughout the study. Results As per the Consolidated Standards of Reporting Trials extension for pilot studies, means of all outcomes, mean change, and 95% CIs will be calculated for each group separately. Two-tailed independent t tests and Fisher exact tests will be used to compare groups at baseline. We will analyze quantitative postintervention questionnaire responses using Chi-square tests, and open-ended responses will be analyzed thematically. Intention-to-treat and per-protocol analyses will be used to analyze secondary variables. Changes in outcome variables will be examined between groups and within groups. Effect sizes will be reported for each outcome. A priori adherence and satisfaction criteria will be met if participants attend >70% of the yoga sessions and if >70% of the participants are satisfied with the intervention as determined by a postparticipation questionnaire. Study enrollment began in January 2018, with results expected for October 2019. Conclusions This pilot randomized trial will be the first to investigate the feasibility and effect of a yoga intervention on cognitive and physical outcomes among PLWH. This work will inform the feasibility of further investigations in terms of capacity building, participant recruitment and retention, and assessment and intervention protocols. Trial Registration ClinicalTrials.gov NCT03071562; https://clinicaltrials.gov/ct2/show/NCT03071562 (Archived by WebCite at http://www.webcitation.org/785sfhWkw) International Registered Report Identifier (IRRID) DERR1-10.2196/13818
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Affiliation(s)
- Adria Quigley
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
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Tomita A, Ramlall S, Naidu T, Mthembu SS, Padayatchi N, Burns JK. Neurocognitive Impairment Risk Among Individuals With Multiple Drug-Resistant Tuberculosis and Human Immunodeficiency Virus Coinfection: Implications for Systematic Linkage to and Retention of Care in Tuberculosis/Human Immunodeficiency Virus Treatment. J Nerv Ment Dis 2019; 207:307-310. [PMID: 30920478 PMCID: PMC6541922 DOI: 10.1097/nmd.0000000000000962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Although neurocognitive impairment (NCI) is a well-recognized challenge in human immunodeficiency virus (HIV), there is little evidence regarding it among individuals with multiple drug-resistant tuberculosis (MDR-TB) within HIV endemic sub-Saharan Africa. The extent of NCI risk, particularly HIV-associated neurocognitive disorders (HAND) risk, was investigated in 200 microbiologically confirmed inpatients with MDR-TB at a TB-specialist hospital in KwaZulu-Natal Province, South Africa. Within this population, the prevalence of HIV coinfection, major depressive episode, and substance use disorder was 89.50%, 10.50%, and 7.00%, respectively. After excluding individuals with major depressive episode/substance use disorder and monoinfection (i.e., MDR-TB without HIV), the prevalence of HAND risk was 43.5%. Older and low-income individuals had significantly greater odds of HAND risk, whereas those with family members/relatives who work(ed) in the health services had lower odds. The role of timely linkage to and retention of care in TB/HIV treatment to offset cognitive decline in MDR-TB/HIV coinfected individuals needs to be investigated further.
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Affiliation(s)
- Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Corresponding author: Andrew Tomita. Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa., ., Telephone: +27 (0)31-260-4321
| | - Suvira Ramlall
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | - Thirusha Naidu
- Department of Behavioural Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Nesri Padayatchi
- MRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Jonathan K. Burns
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa.,Institute of Health Research, University of Exeter, Exeter, United Kingdom
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Debalkie Animut M, Sorrie MB, Birhanu YW, Teshale MY. High prevalence of neurocognitive disorders observed among adult people living with HIV/AIDS in Southern Ethiopia: A cross-sectional study. PLoS One 2019; 14:e0204636. [PMID: 30883557 PMCID: PMC6422272 DOI: 10.1371/journal.pone.0204636] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/28/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Comprehensive care given to people living with HIV/AIDS is improving over time; however, their concurrent cognitive illness is still ignored, under screened and treated particularly in developing countries. And this problem is also striking in Ethiopia. Therefore, the objective of this study was to assess HIV-associated neurocognitive disorders and associated factors among adult people living with HIV/AIDS. METHODS An institution based cross sectional study was conducted from April to May, 2017 at Gamo Gofa zone public Hospitals. International HIV Dementia Scale was used to screen HIV associated neurocognitive disorders. Logistic regression analysis was used to assess predictors of neurocognitive disorders. RESULT A total of 684 study participants were included in this study with a response rate of 98%. Among them, 56% were females while 44% were males. The mean (±SD) age of the participants was 38.8±8.8years. The screening prevalence of HIV-associated neurocognitive disorder was 67.1% (95% CI; 63.6, 70.5). Body mass index 16 kg/m2 (AOR 4.389 (1.603-12.016)), being married (AOR 0.377 (0.213-0.666), unemployment status (AOR 3.181 (1.752-5.777) and being in WHO clinical stage T3 category/advancing stages of the disease (AOR 3.558 (1.406-9.006) were the key predictors of HIV-associated neurocognitive disorders among people living with HIV/AIDS. CONCLUSION In this study the screening prevalence of HIV-associated neurocognitive disorder is higher than the earlier reports in Ethiopia and Africa. This indicates that early screening strategies and policies for cognitive health in people living with HIV/AIDS should be given a top priority.
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Affiliation(s)
- Megbaru Debalkie Animut
- Arbaminch University College of Medicine and Health Sciences Department of Nursing, Arbaminch, Ethiopia
| | - Muluken Bekele Sorrie
- Arbaminch University College of Medicine and Health Sciences Department of Public Health, Arbaminch, Ethiopia
| | - Yinager Workineh Birhanu
- Bahir Dar University Colleges of Medicine and Health Sciences School of Nursing, Bahir Dar Ethiopia
| | - Manaye Yihune Teshale
- Arbaminch University College of Medicine and Health Sciences Department of Public Health, Arbaminch, Ethiopia
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Jones JD, Kuhn T, Levine A, Sacktor N, Munro CA, Teplin LA, D'Souza G, Martin EM, Becker JT, Miller EN, Hinkin CH. Changes in cognition precede changes in HRQoL among HIV+ males: Longitudinal analysis of the multicenter AIDS cohort study. Neuropsychology 2019; 33:370-378. [PMID: 30816783 PMCID: PMC6666308 DOI: 10.1037/neu0000530] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Despite treatment-related improvements in morbidity and mortality, HIV-1-infected (HIV+) individuals continue to face a wide range of HIV-associated medical and HIV-associated neurocognitive disorders. Little is known about the impact of cognitive impairment on patients' health-related quality of life (HRQoL). To address this, the current study examined the longitudinal relationship between cognitive functioning and HRQoL among HIV+ individuals. METHOD The sample consisted of 1,306 HIV+ men enrolled in the Multicenter AIDS Cohort Study. Participants received biannual assessments of cognitive functioning (including tests of processing speed, executive functioning, attention/working memory, motor functioning, learning, and memory) and completed questionnaires assessing HRQoL and depression. Multilevel models were used to examine the longitudinal and cross-lagged relationship between HRQoL and cognition, independent of depression and HIV disease severity. RESULTS There was a significant relationship between HRQoL and cognitive functioning both between and within subjects. Specifically, individuals who reported better HRQoL reported better cognitive functioning, and longitudinal change in cognition was positively related to change in HRQoL. There was a significant unidirectional-lagged relationship; cognition predicted HRQoL at subsequent visits, but HRQoL did not predict cognitive functioning at subsequent visits. Furthermore, analyses of severity of neurocognitive impairment revealed that transition to a more severe stage of cognitive impairment was associated with a decline in HRQoL. CONCLUSIONS Overall, the current study suggests that changes in HRQoL are partially driven by changes in cognitive functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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East African HIV care: depression and HIV outcomes. Glob Ment Health (Camb) 2019; 6:e9. [PMID: 31258923 PMCID: PMC6582461 DOI: 10.1017/gmh.2019.6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Depression is a common co-morbidity for people living with HIV (PLWH) and is associated with elevated plasma HIV RNA levels. While depression correlates with deficits in antiretroviral (ARV) adherence, little data exist to inform the relationship between depression and HIV vial load more broadly. OBJECTIVE To examine the relationship between depression and viral load in the African Cohort Study (AFRICOS) independently of ARV adherence. DESIGN PLWH in Kenya, Uganda and Tanzania underwent screening for depression using the Center for Epidemiologic Studies Depression Scale (CESD) upon enrollment at AFRICOS HIV care sites. SETTING AFRICOS is an ongoing prospective longitudinal cohort study enrolling HIV-infected adults at HIV care centers including sites in Kenya, Tanzania and Uganda. These sites are administered by President's Emergency Plan For AIDS Relief programs. PARTICIPANTS HIV+ individuals were eligible if they were at least 18 years old, receiving HIV care at the enrolling clinic and consented to data and specimen collection. MAIN OUTCOME MEASURE CESD. RESULTS Among 2307 participants, 18-25% met the CESD threshold for depression. Depression was associated with decreased ARV adherence (OR 0.59, p = 0.01). Higher scores on three CESD items were significantly associated with 209-282% higher viral load, independently of ARV adherence among participants on ARVs ⩾6 months. CONCLUSIONS PLWH had high prevalence of depression on the CESD. Diverse depression symptoms were independently associated with increases in viral load, underscoring the need for comprehensive treatment of depression.
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Spies G, Denckla CA, Mall S, Levin J, Seedat S, Nakasujja N, Kinyanda E. The relationship between cognitive change and physical health and behavioural outcomes in a Ugandan cohort of adults living with HIV - a longitudinal study. AIDS Care 2018; 31:803-808. [PMID: 30421989 DOI: 10.1080/09540121.2018.1545987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We investigated changes in cognitive function and physical health and behavioural outcomes (HIV disease progression, health-seeking behaviour, adherence to HIV medications and risky sexual behaviour) at baseline and 12 months later among 1126 Ugandan adults living with HIV. Overall, cognitive function improved from baseline to follow-up, except for gait speed, which was slower at follow-up compared to baseline. There were improvements in physical health and behavioural outcomes by follow-up, with greater improvements among individuals on ART compared to those not on ART. Change in gait speed over time significantly predicted risky sexual behaviours at follow-up. This is the first study to investigate the longitudinal relationships between cognitive function and health outcomes among Ugandan adults living with HIV and provide insights into the possible links between cognitive function and negative clinical and behavioural health outcomes in people living with HIV.
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Affiliation(s)
- G Spies
- a Department of Psychiatry, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - C A Denckla
- b Department of Epidemiology , Harvard T. H. Chan School of Public Health , Cambridge , MA , USA
| | - S Mall
- c Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - J Levin
- c Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,d Statistical Section , MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda
| | - S Seedat
- a Department of Psychiatry, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - N Nakasujja
- e Department of Psychiatry , Makerere University , Kampala , Uganda
| | - E Kinyanda
- e Department of Psychiatry , Makerere University , Kampala , Uganda.,f Mental Health Project, MRC/LSHTM/UVRI and Senior Wellcome Trust Fellow , Uganda
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Mahmood Z, Hammond A, Nunez RA, Irwin MR, Thames AD. Effects of Sleep Health on Cognitive Function in HIV+ and HIV- Adults. J Int Neuropsychol Soc 2018; 24:1038-1046. [PMID: 30165914 PMCID: PMC6237632 DOI: 10.1017/s1355617718000607] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) are more likely to report sleep difficulties and cognitive deficits. While cognitive impairment associated with sleep problems have been found in healthy and medical populations, less is known about the effects of poor sleep health (SH) on cognition among PLWH. This study examined differences in cognitive performance among participants classified based upon their HIV status and reported SH. METHODS One hundred sixteen (N=116) adults recruited from the Greater Los Angeles community were administered a comprehensive cognitive test battery and completed a questionnaire about SH. Participants were classified into the following HIV/SH groups: [HIV+/good sleep health (SH+; n=34); HIV-/SH+ (n=32); HIV-/poor sleep health (SH-; n=18) and HIV+/SH- (n=32)]. RESULTS For both HIV+ and HIV- individuals, poor SH was associated with lower cognitive performance, with the domains of learning and memory driving the overall relationship. The HIV+/SH- group had poorer scores in domains of learning and memory compared to the SH+ groups. Additionally, the HIV-/SH- group demonstrated poorer learning compared to the HIV-/SH+ group. CONCLUSIONS Our findings suggest that sleep problems within medical populations are relevant to cognitive functioning, highlighting the clinical and scientific importance of monitoring sleep health and cognition to help identify individuals at greatest risk of poor health outcomes. Longitudinal investigations using both objective and subjective measures of sleep are needed to determine the robustness of the current findings and the enduring effects of poor SH in the context of chronic disease. (JINS, 2018, 24, 1038-1046).
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Affiliation(s)
- Zanjbeel Mahmood
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 740 Westwood Plaza 28-263, Los Angeles, CA 90095
| | - Andrea Hammond
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 740 Westwood Plaza 28-263, Los Angeles, CA 90095
| | - Rodolfo A. Nunez
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 740 Westwood Plaza 28-263, Los Angeles, CA 90095
- Department of Psychology, University of California Los Angeles, Franz Hall, 502 Portola Plaza Los Angeles, CA 90095
| | - Michael R. Irwin
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 740 Westwood Plaza 28-263, Los Angeles, CA 90095
| | - April D. Thames
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 740 Westwood Plaza 28-263, Los Angeles, CA 90095
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Moore RC, Hussain MA, Watson CWM, Fazeli PL, Marquine MJ, Yarns BC, Jeste DV, Moore DJ. Grit and Ambition are Associated with Better Neurocognitive and Everyday Functioning Among Adults Living with HIV. AIDS Behav 2018; 22:3214-3225. [PMID: 29455265 DOI: 10.1007/s10461-018-2061-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Grit and ambition are psychological factors that may protect neurocognitive function among persons living with HIV (PLWH). We examined associations between grit, ambition, premorbid verbal intellectual function, and current neurocognitive and everyday functioning among PLWH and persons without HIV (HIV-). 120 PLWH and 94 HIV- adults completed the Grit Scale (includes total score and consistency of interests and perseverance of effort subscales), ambition scale, and a comprehensive neurobehavioral battery. PLWH had lower grit scores than HIV- adults. The two groups did not differ on ambition. No relationship was observed between grit and cognition among HIV- adults. Among PLWH, however, higher perseverance of effort and more ambition was related to better global neurocognitive functioning, and higher grit, but not ambition, was related to independence in daily functioning. Longitudinal studies are needed to elucidate these relationships over time and examine whether grit or ambition have protective effects on cognitive outcomes among PLWH.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Drive, St B (8231), San Diego, CA, 92103-8231, USA.
- VA San Diego Healthcare System, San Diego, CA, USA.
| | - Mariam A Hussain
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Caitlin W-M Watson
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Pariya L Fazeli
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - María J Marquine
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Drive, St B (8231), San Diego, CA, 92103-8231, USA
| | - Brandon C Yarns
- Department of Medicine, Division of General Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Psychiatry (BCY), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Drive, St B (8231), San Diego, CA, 92103-8231, USA
- Department of Neurosciences, University of California, San Diego, CA, USA
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Drive, St B (8231), San Diego, CA, 92103-8231, USA
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Thames AD, Kuhn TP, Mahmood Z, Bilder RM, Williamson TJ, Singer EJ, Arentoft A. Effects of social adversity and HIV on subcortical shape and neurocognitive function. Brain Imaging Behav 2018; 12:96-108. [PMID: 28130744 PMCID: PMC5529267 DOI: 10.1007/s11682-017-9676-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of the current study was to examine the independent and interactive effects of social adversity (SA) and HIV infection on subcortical shape alterations and cognitive functions. Participants included HIV+ (n = 70) and HIV- (n = 23) individuals who underwent MRI, neurocognitive and clinical assessment, in addition to completing questionnaires from which responses were used to create an SA score. Bilateral amygdalae and hippocampi were extracted from T1-weighted images. Parametric statistical analyses were used to compare the radial distance of the structure surface to a median curve to determine the presence of localized shape differences as a function of HIV, SA and their interaction. Next, multiple regression was used to examine the interactive association between HIV and SA with cognitive performance data. An HIV*SA interactive effect was found on the shape of the right amygdala and left hippocampus. Specifically, HIV-infected participants (but not HIV-uninfected controls) who evidenced higher levels of SA displayed an inward deformation of the surface consistent with reduced volume of these structures. We found interactive effects of HIV and SA on learning/memory performance. These results suggest that HIV+ individuals may be more vulnerable to neurological and cognitive changes in the hippocampus and amygdala as a function of SA than HIV- individuals, and that SA indicators of childhood SES and perceived racial discrimination are important components of adversity that are associated with cognitive performance.
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Affiliation(s)
- April D Thames
- David Geffen School of Medicine, University of California Los Angeles, 760 Westwood Plaza, 28-263, Los Angeles, CA, 90095, USA.
| | - Taylor P Kuhn
- David Geffen School of Medicine, University of California Los Angeles, 760 Westwood Plaza, 28-263, Los Angeles, CA, 90095, USA
- Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Zanjbeel Mahmood
- David Geffen School of Medicine, University of California Los Angeles, 760 Westwood Plaza, 28-263, Los Angeles, CA, 90095, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert M Bilder
- David Geffen School of Medicine, University of California Los Angeles, 760 Westwood Plaza, 28-263, Los Angeles, CA, 90095, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Timothy J Williamson
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Elyse J Singer
- David Geffen School of Medicine, University of California Los Angeles, 760 Westwood Plaza, 28-263, Los Angeles, CA, 90095, USA
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Yoo-Jeong M, Anderson A, Rahman AKMF, Baumann M, McBroom J, Waldrop-Valverde D. Associations of Mood on Objective and Subjective Cognitive Complaints in Persons Living with HIV/AIDS. JOURNAL OF HIV AND AIDS 2018; 4:10.16966/2380-5536.146. [PMID: 29732416 PMCID: PMC5935453 DOI: 10.16966/2380-5536.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Healthcare workers commonly rely on patient self-report to identify problems with cognitive functioning among Persons Living with HIV (PLWH). Self-reported cognitive complaints may not accurately reflect objective cognitive performance and may be obscured by co-occurring depression. The purpose of the current study was to examine the relationships among depression, subjective cognitive complaints, and objective cognitive performance in PLWH using measures easily administered by healthcare workers. Particularly, this study assessed the association between subjective cognitive complaints (MOS-HIV) and objective cognitive performance (mHDS) using a simple screening tool, as well as whether depressive symptoms (CES-D 10) moderated this relationship. This was a secondary data analysis of a parent study that enrolled participants (N=207) from outpatient HIV clinics in Florida between 2009 and 2011. Most participants identified themselves as African American (82.6%) and heterosexual (81.6%). Almost half of the participants were male (46.4%). Fifty-one percent of participants had a score of 10 or greater on CES-D, indicating clinical depression. This study found no association between subjective and objective cognitive measures; depressive symptoms exhibited no moderating effect on the relationship between subjective cognitive complaints and objective cognitive performance. Depressive symptoms were significantly associated with subjective perceptions of cognitive ability. Results suggest that subjective cognitive complaints may be an inadequate tool for identifying objective cognitive impairments among PLWH. Additionally, treatment of depressive symptoms may help alleviate subjective cognitive complaints.
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Affiliation(s)
- Moka Yoo-Jeong
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - Ashley Anderson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - AKM Fazlur Rahman
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, USA
| | - Maya Baumann
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - Jade McBroom
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
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Gascón MRP, Vidal JE, Mazzaro YM, Smid J, Marcusso RMN, Capitão CG, Coutinho EM, Benute GRG, De Lucia MCS, de Oliveira ACP. Neuropsychological Assessment of 412 HIV-Infected Individuals in São Paulo, Brazil. AIDS Patient Care STDS 2018; 32:1-8. [PMID: 29323557 DOI: 10.1089/apc.2017.0202] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
HIV-associated neurocognitive disorders (HAND) remain frequent even among individuals receiving combined antiretroviral therapy (cART). In addition, HAND may adversely affect the quality of life and adherence to cART. There is scarce epidemiological information about HAND in Latin America. This cross-sectional study recruited HIV-infected patients from a tertiary teaching institution in São Paulo, Brazil, between May 2013 and February 2015. The patients were adults with at least 4 years of education and patients with current neurological or psychiatric diseases were excluded. HAND remain frequent even among individuals receiving cART, use of psychoactive substance, or inability to understand the content for neuropsychological evaluation. We used standardized tools to evaluate depression, use of psychoactive substances, and daily life activities, and we performed a comprehensive neuropsychological examination. HAND was classified using the Frascati criteria. Prevalence of HAND was estimated, and an associated variable of symptomatic HAND was identified by logistic regression. Four-hundred twelve HIV-infected patients were included [male: 281 (68%), mean age of 45.3 years]. Most of them [n = 340 (83.7%)] had an undetectable viral load. The prevalence of HAND was 73.6% (n = 303): 210 (50.9%) had asymptomatic neurocognitive involvement (ANI), 67 (16.2%) had mild neurocognitive disorder (MND), and 26 (6.3%) had HIV-associated dementia (HAD). The univariate logistic regression analysis showed that female gender, age older than 50 years, <11 years of schooling, CD4 count below 200 cells/mm3, presence of previous illnesses (e.g., diabetes, hypertension), opportunistic disease history, and a Beck Depression Inventory (BDI) score between 13 and 19 points were factors associated with symptomatic HAND (MND and HAD). However, a BDI score between 13 and 19 points was the single independent variable associated with symptomatic HAND. HAND was highly prevalent in São Paulo, Brazil, and ANI was the more frequent category of HAND. However, 22.5% of participants had symptomatic HAND. This finding constitutes a challenge in clinical practice. A BDI score between 13 and 19 points was the single independent variable associated with symptomatic HAND.
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Affiliation(s)
- Maria Rita Polo Gascón
- Division of Psychology, Central Institute of Hospital das Clinicas, Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - José Ernesto Vidal
- Department of Neurology, Institute of Infectology Emilio Ribas, São Paulo, Brazil
| | - Yolanda Marques Mazzaro
- Division of Psychology, Central Institute of Hospital das Clinicas, Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Jerusa Smid
- Department of Neurology, Institute of Infectology Emilio Ribas, São Paulo, Brazil
| | | | | | | | - Glaucia Rosana Guerra Benute
- Division of Psychology, Central Institute of Hospital das Clinicas, Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Mara Cristina Souza De Lucia
- Division of Psychology, Central Institute of Hospital das Clinicas, Faculdade de Medicina de São Paulo, São Paulo, Brazil
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Frain JA, Chen L. Examining the effectiveness of a cognitive intervention to improve cognitive function in a population of older adults living with HIV: a pilot study. Ther Adv Infect Dis 2018; 5:19-28. [PMID: 29344357 PMCID: PMC5761923 DOI: 10.1177/2049936117736456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The purpose of this randomized-controlled pilot study was to explore the effectiveness of a home-based computerized cognitive training intervention in improving cognitive function in a population of older adults with mild cognitive impairment who are living with HIV. METHODS In all, 24 participants were enrolled in this study. All study participants were impaired [defined as Montreal Cognitive Assessment (MoCA) score < 26]; 12 were randomly assigned to a computer-training intervention group and 12 to a control group. The intervention group used a home-based computerized cognitive training program for 8 weeks, while the control group received health-related newsletter via email and follow-up phone calls. Cognitive function was measured at study entry, immediately post intervention, and 8 and 16 weeks post intervention. RESULTS This study achieved a 92% retention rate, losing two persons from the intervention group. Participants in the intervention group scored significantly higher on cognitive testing immediately post intervention compared to the control group: F(1, 19) = 4.92, p = 0.04. The partial Eta squared of 0.32 indicates a small to moderate effect size. DISCUSSION Cognitive improvement was seen immediately after the intervention, and cognitive improvement was still evident 16 weeks post intervention. Cognitive training could be considered as an option for older adults with HIV experiencing mild cognitive impairment.
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Affiliation(s)
- Judy A. Frain
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO, USA
| | - Ling Chen
- Washington University in St. Louis, St. Louis, MO, USA
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Vance DE, Fazeli PL, Azuero A, Wadley VG, Jensen M, Raper JL. Can computerized cognitive training reverse the diagnosis of HIV-associated neurocognitive disorder? A research protocol. Res Nurs Health 2017; 41:11-18. [PMID: 29266286 DOI: 10.1002/nur.21841] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/11/2017] [Indexed: 12/13/2022]
Abstract
Nearly 50% of adults with HIV have some form of HIV-associated neurocognitive disorder (HAND), ranging from subtle to symptoms that interfere with everyday functioning and quality of life. HAND is diagnosed when a person performs more than 1 standard deviation below his or her normative mean on standardized measures in two or more cognitive domains (e.g., attention, speed of processing, verbal memory, executive functioning). As adults age with HIV, they are more likely to develop comorbidities such as cardiovascular disease, hypertension, and insulin resistance that may further contribute to poorer cognitive functioning and HAND. Certain computerized cognitive training programs may be able to improve specific cognitive domains in those with HIV. Such programs may be effective in changing the diagnosis of HAND in cognitively vulnerable adults. In this article, we describe the design and methods of TOPS-the Training On Purpose Study. In this on-going experimental study, 146 older adults (50+) with HAND are randomized to either: (i) an Individualized-Targeted Cognitive Training group, or (ii) a no-contact control group. This study targets those cognitive domains in which participants experience a deficit and trains participants with the corresponding computerized cognitive training program for that domain. An Individualized Targeted Cognitive Training approach using cognitive-domain-specific cognitive training programs may offer symptom relief to those individuals diagnosed with HAND, which may actually reverse this diagnosis. Given that these cognitive training programs are commercially available, this approach represents a potential paradigm shift in how HAND is considered and treated.
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Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Virginia G Wadley
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael Jensen
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - James L Raper
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Examining the Acceptability of mHealth Technology in HIV Prevention Among High-Risk Drug Users in Treatment. AIDS Behav 2017; 21:3100-3110. [PMID: 28025735 DOI: 10.1007/s10461-016-1637-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite promising trends of the efficacy of mobile health (mHealth) based strategies to a broad range of health conditions, very few if any studies have been done in terms of the examining the use of mHealth in HIV prevention efforts among people who use drugs in treatment. Thus, the goal of this study was to gain insight into the real-world acceptance of mHealth approaches among high-risk people who use drugs in treatment. A convenience sample of 400 HIV-negative drug users, who reported drug- and/or sex-related risk behaviors, were recruited from a methadone clinic in New Haven, Connecticut. Participants completed standardized assessments of drug- and sex-related risk behaviors, neurocognitive impairment (NCI), and measures of communication technology access and utilization, and mHealth acceptance. We found a high prevalence of current ownership and use of mobile technologies, such as cell phone (91.5%) including smartphone (63.5%). Participants used mobile technologies to communicate mostly through phone calls (M = 4.25, SD = 1.24), followed by text messages (M = 4.21, SD = 1.29). Participants expressed interest in using mHealth for medication reminders (72.3%), receive information about HIV (65.8%), and to assess drug-related (72.3%) and sex-related behaviors (64.8%). Furthermore, participants who were neurocognitively impaired were more likely to use cell phone without internet and show considerable interest in using mHealth as compared to those without NCI. The findings from this study provide empirical evidence that mHealth-based programs, specifically cell phone text messaging-based health programs, may be acceptable to this high-risk population.
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López E, Steiner AJ, Smith K, Thaler NS, Hardy DJ, Levine AJ, Al-Kharafi HT, Yamakawa C, Goodkin K. Diagnostic utility of the HIV dementia scale and the international HIV dementia scale in screening for HIV-associated neurocognitive disorders among Spanish-speaking adults. APPLIED NEUROPSYCHOLOGY. ADULT 2017; 24:512-521. [PMID: 27712132 PMCID: PMC5938065 DOI: 10.1080/23279095.2016.1214835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Given that neurocognitive impairment is a frequent complication of HIV-1 infection in Spanish-speaking adults, the limited number of studies assessing HIV-associated neurocognitive disorders (HAND) in this population raises serious clinical concern. In addition to being appropriately translated, instruments need to be modified, normed, and validated accordingly. The purpose of the current study was to examine the diagnostic utility of the HIV Dementia Scale (HDS) and International HIV Dementia Scale (IHDS) to screen for HAND in Spanish-speaking adults living with HIV infection. Participants were classified as either HAND (N = 47) or No-HAND (N = 53) after completing a comprehensive neuropsychological evaluation. Receiver operating characteristic analyses found the HDS (AUC = .706) was more sensitive to detecting HAND than the IHDS (AUC = .600). Optimal cutoff scores were 9.5 for the HDS (PPV = 65.2%, NPV = 71.4%) and 9.0 for the IHDS (PPV = 59.4%, NPV = 59.1%). Canonical Correlation Analysis found the HDS converged with attention and executive functioning. Findings suggest that while the IHDS may not be an appropriate screening instrument with this population, the HDS retains sufficient statistical validity and clinical utility to screen for HAND in Spanish-speaking adults as a time-efficient and cost-effective measure in clinical settings with limited resources.
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Affiliation(s)
- Enrique López
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alexander J. Steiner
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Psychology, California School of Professional Psychology, Alliant International University, Alhambra, California, USA
| | - Kimberly Smith
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nicholas S. Thaler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - David J. Hardy
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychology, Loyola Marymount University, Los Angeles, California, USA
| | - Andrew J. Levine
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Hussah T. Al-Kharafi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Graduate School of Education and Psychology, Pepperdine University, Los Angeles, California, USA
| | - Cristina Yamakawa
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Karl Goodkin
- Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
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Mogambery JC, Dawood H, Wilson D, Moodley A. HIV-associated neurocognitive disorder in a KwaZulu-Natal HIV clinic: A prospective study. South Afr J HIV Med 2017; 18:732. [PMID: 29568639 PMCID: PMC5843078 DOI: 10.4102/sajhivmed.v18i1.732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/01/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION HIV-associated neurocognitive disorder (HAND) is a consequence of HIV infection of the central nervous system. The prevalence ranges between 15% and 60% in different settings. OBJECTIVES This prospective study determined the prevalence of HAND at a peri-urban HIV clinic in KwaZulu-Natal. Factors associated with HAND were examined, alternate neurocognitive tools were tested against the international HIV dementia scale (IHDS) score and an association between HAND and non-adherence to antiretroviral therapy (ART) was explored. METHODS Between May 2014 and May 2015, 146 ART-naïve outpatients were assessed for HAND. IHDS score ≤ 10 established a diagnosis of HAND. Functional capacity was assessed using Eastern Cooperative Oncology Group (ECOG) score. Chi-squared test was used to identify risk factors for HAND. The get-up-and-go test (GUGT) and Center for Epidemiological Studies Depression scale - revised (CESD-r) were tested against the IHDS. HIV viral load done six months after initiating ART was used as a surrogate marker for adherence to ART. RESULTS The prevalence of HAND was 53%. In total, 99.9% of patients with HAND had no functional impairment. Age > 50 years old was associated with HAND (p = 0.003). There was no correlation between the GUGT, CESD-r and the IHDS score. HAND was not associated with non-adherence (p = 0.06). CONCLUSIONS While the prevalence of HAND is high, it is not associated with functional impairment which suggests that asymptomatic neurocognitive impairment is prevalent. Age > 50 years old is a risk factor for HAND. The GUGT and CESD-r are not useful diagnostic tools for HAND. The relationship between HAND and non-adherence should be further explored.
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Affiliation(s)
- Jade C Mogambery
- Department of Internal Medicine, Ngwelezana Hospital, University of KwaZulu-Natal, South Africa
| | - Halima Dawood
- Department of Internal Medicine, Infectious Diseases Unit, Grey's Hospital, University of KwaZulu-Natal, South Africa
| | - Douglas Wilson
- Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, South Africa
| | - Anand Moodley
- Department of Neurology, Grey's Hospital, University of KwaZulu-Natal, South Africa
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Vidot DC, Lerner B, Gonzalez R. Cannabis Use, Medication Management and Adherence Among Persons Living with HIV. AIDS Behav 2017; 21:2005-2013. [PMID: 28456895 DOI: 10.1007/s10461-017-1782-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cannabis is used to relieve nausea, trigger weight gain, and reduce pain among adults living with HIV; however, the relationship between its use and medication adherence and management is unclear. Participants (N = 107) were from an ongoing cohort study of community-dwelling HIV+ adults, stratified by cannabis (CB) use: HIV+/CB+ (n = 41) and HIV+/CB- (n = 66). CB+ participants either tested positive in a urine toxicology screen for THC or had a self-reported history of regular and recent use. HIV-status was provided by physician results and/or biomarker assessment. Adherence was measured via the Morisky scale and medication management was assessed via the Medication Management Test-Revised. After adjusting for gender, we found no association between cannabis use group and adherence nor medication management. The amount of cannabis used was also not associated with measures of adherence and management. Preliminary findings suggest that cannabis use may not adversely influence medication adherence/management among adults living with HIV.
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Affiliation(s)
- Denise C Vidot
- School of Nursing and Health Sciences, University of Miami, 5030 Brunson Ave, Coral Gables, FL, 33146, USA.
| | - Brenda Lerner
- Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA
| | - Raul Gonzalez
- Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA
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Cognitive Decline in Relation to Psychological Wellbeing and HIV Disease- and Treatment Characteristics in HIV-Infected Patients on cART: A One-Year Follow-Up Study. AIDS Behav 2017; 21:1728-1734. [PMID: 27752871 PMCID: PMC5422495 DOI: 10.1007/s10461-016-1583-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objectives of the current study were to examine cognitive decline in relation to psychological wellbeing, HIV disease and treatment characteristics and baseline variables over a one-year period of time in a group of HIV-infected patients on long term cART with undetectable viral load in comparison to a HIV-negative control group. Eighty-two of 95 patients and 43 of 55 controls who completed a baseline assessment for the Art-NeCo study underwent a follow-up neuropsychological assessment. A repeated-measure general linear model analysis was performed to compare the performance at follow-up in comparison to baseline between the patients and controls. Reliable change indices were computed as a measure of significant change in cognitive function. Compared to controls, patients overall performed worse on the domain speed of information processing. In the patient group a worse performance at follow-up was present for the verbal fluency domain compared to the controls, in the absence of a baseline group difference. For the executive function domain, no group differences were found at follow-up, but the patients performed worse than the controls at baseline. We found that cognitive decline was related to more frequent use of recreational drugs and a somewhat heightened level of irritability and more somatic complaints at baseline. However, the decliners did not differ from the non-decliners on any of the HIV-related variables.
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Cleutjens FAHM, Spruit MA, Ponds RWHM, Vanfleteren LEGW, Franssen FME, Gijsen C, Dijkstra JB, Wouters EFM, Janssen DJA. Cognitive impairment and clinical characteristics in patients with chronic obstructive pulmonary disease. Chron Respir Dis 2017; 15:91-102. [PMID: 28553720 PMCID: PMC5958463 DOI: 10.1177/1479972317709651] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
We aimed to investigate (1) the relationship between cognitive impairment (CI) and
disease severity and (2) the potential differences in exercise performance, daily
activities, health status, and psychological well-being between patients with and without
CI. Clinically stable chronic obstructive pulmonary disease (COPD) patients, referred for
pulmonary rehabilitation, underwent a neuropsychological examination. Functional exercise
capacity (6-minute walk test [6MWT]), daily activities (Canadian Occupational Performance
Measure [COPM]), health status (COPD Assessment Test [CAT]) and St George’s Respiratory
Questionnaire-COPD specific [SGRQ-C]), and psychological well-being (Hospital Anxiety and
Depression Scale [HADS], Beck Depression Inventory [BDI], and Symptom Checklist 90
[SCL-90]) were compared between patients with and without CI. Of 183 COPD patients (mean
age 63.6 (9.4) years, FEV1 54.8 (23.0%) predicted), 76 (41.5%) patients had CI.
The prevalence was comparable across Global Initiative for Chronic Obstructive Lung
Disease (GOLD) grades 1–4 (44.8%, 40.0%, 41.0%, 43.5%, respectively, p =
0.97) and GOLD groups A–D (50.0%, 44.7%, 33.3%, 40.2%, respectively, p =
0.91). Patients with and without CI were comparable for demographics, smoking status,
FEV1% predicted, mMRC, 6MWT, COPM, CAT, HADS, BDI, and SCL-90 scores.
Clinical characteristics of COPD patients with and without CI are comparable. Assessment
of CI in COPD, thus, requires an active case-finding approach.
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Affiliation(s)
- Fiona A H M Cleutjens
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands
| | - Martijn A Spruit
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands.,2 Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Rudolf W H M Ponds
- 3 Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS), Maastricht, the Netherlands
| | - Lowie E G W Vanfleteren
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands
| | - Frits M E Franssen
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands
| | - Candy Gijsen
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands
| | - Jeanette B Dijkstra
- 3 Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS), Maastricht, the Netherlands
| | - Emiel F M Wouters
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands.,4 Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Daisy J A Janssen
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands
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Shrestha R, Altice F, Karki P, Copenhaver M. Developing an Integrated, Brief Biobehavioral HIV Prevention Intervention for High-Risk Drug Users in Treatment: The Process and Outcome of Formative Research. Front Immunol 2017; 8:561. [PMID: 28553295 PMCID: PMC5425476 DOI: 10.3389/fimmu.2017.00561] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/26/2017] [Indexed: 11/13/2022] Open
Abstract
To date, HIV prevention efforts have largely relied on singular strategies (e.g., behavioral or biomedical approaches alone) with modest HIV risk-reduction outcomes for people who use drugs (PWUD), many of whom experience a wide range of neurocognitive impairments (NCI). We report on the process and outcome of our formative research aimed at developing an integrated biobehavioral approach that incorporates innovative strategies to address the HIV prevention and cognitive needs of high-risk PWUD in drug treatment. Our formative work involved first adapting an evidence-based behavioral intervention-guided by the Assessment-Decision-Administration-Production-Topical experts-Integration-Training-Testing model-and then combining the behavioral intervention with an evidence-based biomedical intervention for implementation among the target population. This process involved eliciting data through structured focus groups (FGs) with key stakeholders-members of the target population (n = 20) and treatment providers (n = 10). Analysis of FG data followed a thematic analysis approach utilizing several qualitative data analysis techniques, including inductive analysis and cross-case analysis. Based on all information, we integrated the adapted community-friendly health recovery program-a brief evidence-based HIV prevention behavioral intervention-with the evidence-based biomedical component [i.e., preexposure prophylaxis (PrEP)], an approach that incorporates innovative strategies to accommodate individuals with NCI. This combination approach-now called the biobehavioral community-friendly health recovery program-is designed to address HIV-related risk behaviors and PrEP uptake and adherence as experienced by many PWUD in treatment. This study provides a complete example of the process of selecting, adapting, and integrating the evidence-based interventions-taking into account both empirical evidence and input from target population members and target organization stakeholders. The resultant brief evidence-based biobehavioral approach could significantly advance primary prevention science by cost-effectively optimizing PrEP adherence and HIV risk reduction within common drug treatment settings.
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Affiliation(s)
- Roman Shrestha
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA.,Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Frederick Altice
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.,AIDS Program, Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Pramila Karki
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.,Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Michael Copenhaver
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.,Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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Cleutjens FA, Spruit MA, Ponds RW, Vanfleteren LE, Franssen FM, Dijkstra JB, Gijsen C, Wouters EF, Janssen DJ. The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD. J Am Med Dir Assoc 2017; 18:420-426. [DOI: 10.1016/j.jamda.2016.11.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
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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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Shrestha R, Karki P, Altice FL, Huedo-Medina TB, Meyer JP, Madden L, Copenhaver M. Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment. Drug Alcohol Depend 2017; 173:107-116. [PMID: 28214391 PMCID: PMC5366273 DOI: 10.1016/j.drugalcdep.2016.12.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/23/2016] [Accepted: 12/18/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although people who use drugs (PWUD) are key populations recommended to receive pre-exposure prophylaxis (PrEP) to prevent HIV, few data are available to guide PrEP delivery in this underserved group. We therefore examined the willingness to initiate PrEP and the anticipation of HIV risk reduction while on PrEP among high-risk PWUD. METHODS In a cross-sectional study of 400 HIV-negative, opioid dependent persons enrolled in a methadone program and reporting recent risk behaviors, we examined independent correlates of being willing to initiate PrEP. RESULTS While only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. This outcome was associated with having neurocognitive impairment (aOR=3.184, p=0.004) and higher perceived HIV risk (aOR=8.044, p<0.001). Among those willing to initiate PrEP, only 12.5% and 28.2%, respectively, indicated that they would always use condoms and not share injection equipment while on PrEP. Consistent condom use was associated with higher income (aOR=8.315, p=0.016), always using condoms with casual partners (aOR=6.597, p=0.001), and inversely associated with ongoing drug injection (aOR=0.323, p=0.027). Consistent safe injection, however, was inversely associated with age (aOR=0.948, p=0.035), ongoing drug injection (aOR=0.342, p<0.001), and perceived HIV risk (aOR=0.191, p=0.019). CONCLUSIONS While willingness to initiate PrEP was high and correlated with being at elevated risk for HIV, anticipated higher risk behaviors in this group even while on PrEP suggests that the next generation of HIV prevention approaches may need to combine biomedical and behavioral components to sustain HIV risk reduction over time.
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Affiliation(s)
- Roman Shrestha
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA; Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.
| | - Pramila Karki
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Frederick L Altice
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Internal Medicine, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Tania B Huedo-Medina
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Jaimie P Meyer
- Department of Internal Medicine, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | | | - Michael Copenhaver
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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49
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A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS One 2017; 12:e0170651. [PMID: 28166234 PMCID: PMC5293218 DOI: 10.1371/journal.pone.0170651] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022] Open
Abstract
Background Adherence to medication is vital for disease management while simultaneously reducing healthcare expenditure. Older persons with cognitive impairment (CI) are at risk for non-adherence as cognitive processes are needed to manage medications. This systematic review focuses on the relationship between medication non-adherence and specific cognitive domains in persons with CI, and explores determinants of medication non-adherence. When available, relationships and factors are compared with cognitively intact populations. Methods A seven database systematic search of studies published between 1 January 1949–31 December 2015 examining medication non-adherence in community dwelling persons with CI or dementia was conducted. Articles reporting medication non-adherence in people with CI or dementia in the community, with or without caregiver supports were eligible for inclusion. Papers reporting adherence to treatments in cognitively intact populations, populations from hospital or institutional settings, for non-prescribed medication or those describing dementia as a factor predicting medication non-adherence were excluded. Data on study and population characteristics, research design, data sources and analysis, specific cognitive domains, non-adherence prevalence, measurement of adherence, salient findings, factors associated with adherence and strategies to improve medication adherence were extracted. Study limitations included inconsistencies between data sources and definitions, resulting in a loss of fidelity in the value and comprehensiveness of data, as well as exclusion of non-pharmacological treatments and regimens. Findings Fifteen studies met inclusion criteria. Adherence among CI subjects ranged from 10.7%-38% with better rates of adherence in non-CI individuals. Medication non-adherence definitions varied considerably. New-learning, memory and executive functioning were associated with improved adherence and formed the focus of most studies. Multiple factors were identified as modulators of non-adherence. Conclusion This review highlights a gap in knowledge on how specific cognitive domains contribute to medication non-adherence amongst CI populations, and demonstrates the current focus is limited to two domains: memory and executive functioning.
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50
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Cleutjens FA, Franssen FM, Spruit MA, Vanfleteren LE, Gijsen C, Dijkstra JB, Ponds RW, Wouters EF, Janssen DJ. Domain-specific cognitive impairment in patients with COPD and control subjects. Int J Chron Obstruct Pulmon Dis 2016; 12:1-11. [PMID: 28031706 PMCID: PMC5182042 DOI: 10.2147/copd.s119633] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Impaired cognitive function is increasingly recognized in COPD. Yet, the prevalence of cognitive impairment in specific cognitive domains in COPD has been poorly studied. The aim of this cross-sectional observational study was to compare the prevalence of domain-specific cognitive impairment between patients with COPD and non-COPD controls. A neuropsychological assessment was administered in 90 stable COPD patients and 90 non-COPD controls with comparable smoking status, age, and level of education. Six core tests from the Maastricht Aging Study were used to assess general cognitive impairment. By using Z-scores, compound scores were constructed for the following domains: psychomotor speed, planning, working memory, verbal memory, and cognitive flexibility. General cognitive impairment and domain-specific cognitive impairment were compared between COPD patients and controls after correction for comorbidities using multivariate linear and logistic regression models. General cognitive impairment was found in 56.7% of patients with COPD and in 13.3% of controls. Deficits in the following domains were more often present in patients with COPD after correction for comorbidities: psychomotor speed (17.8% vs 3.3%; P<0.001), planning (17.8% vs 1.1%; P<0.001), and cognitive flexibility (43.3% vs 12.2%; P<0.001). General cognitive impairment and impairments in the domains psychomotor speed, planning, and cognitive flexibility affect the COPD patients more than their matched controls.
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Affiliation(s)
- Fiona Ahm Cleutjens
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
| | - Frits Me Franssen
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
| | - Martijn A Spruit
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
| | - Lowie Egw Vanfleteren
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
| | - Candy Gijsen
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
| | - Jeanette B Dijkstra
- Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS)
| | - Rudolf Whm Ponds
- Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS)
| | - Emiel Fm Wouters
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn; Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Daisy Ja Janssen
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
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