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Moschopoulos CD, Alford K, Antoniadou A, Vera JH. Cognitive impairment in people living with HIV: mechanisms, controversies, and future perspectives. Trends Mol Med 2024:S1471-4914(24)00163-1. [PMID: 38955654 DOI: 10.1016/j.molmed.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
Despite the dramatic decrease in HIV-associated neurocognitive impairment (NCI) in the combined antiretroviral treatment (cART) era, subtler neuropsychological complications remain prevalent. In this review, we discuss the changing pathophysiology of HIV-associated NCI, considering recent evidence of HIV neuropathogenesis, and the pivotal role of cART. Furthermore, we address the multifactorial nature of NCI in people living with HIV, including legacy and ongoing insults to the brain, as well as host-specific factors. We also summarize the ongoing debate about the refinement of diagnostic criteria, exploring the strengths and limitations of these recent approaches. Finally, we present current research in NCI management in people living with HIV and highlight the need for using both pharmacological and nonpharmacological pathways toward a holistic approach.
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Affiliation(s)
- Charalampos D Moschopoulos
- Fourth Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
| | - Kate Alford
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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Maurage P, Rolland B, Pitel AL, D'Hondt F. Five Challenges in Implementing Cognitive Remediation for Patients with Substance Use Disorders in Clinical Settings. Neuropsychol Rev 2023:10.1007/s11065-023-09623-1. [PMID: 37843739 DOI: 10.1007/s11065-023-09623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Many patients with substance use disorders (SUDs) present cognitive deficits, which are associated with clinical outcomes. Neuropsychological remediation might help rehabilitate cognitive functions in these populations, hence improving treatment effectiveness. Nardo and colleagues (Neuropsychology Review, 32, 161-191, 2022) reviewed 32 studies applying cognitive remediation for patients with SUDs. They underlined the heterogeneity and lack of quality of studies in this research field but concluded that cognitive remediation remains a promising tool for addictive disorders. We capitalize on the insights of this review to identify the key barriers that currently hinder the practical implementation of cognitive remediation in clinical settings. We outline five issues to be addressed, namely, (1) the integration of cognitive remediation in clinical practices; (2) the selection criteria and individual factors to consider; (3) the timing to be followed; (4) the priority across trained cognitive functions; and (5) the generalization of the improvements obtained. We finally propose that cognitive remediation should not be limited to classical cognitive functions but should also be extended toward substance-related biases and social cognition, two categories of processes that are also involved in the emergence and persistence of SUDs.
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Affiliation(s)
- Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-La-Neuve, Belgium.
- Faculté de Psychologie, Place du Cardinal Mercier, 10, B-1348, Louvain-La-Neuve, Belgium.
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, CH Le Vinatier, Lyon, France & PSYR, CRNL, INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, INSERM, U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain @ Caen-Normandie, Cyceron, France
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, Lille, France
- Centre National de Ressources Et de Résilience Lille-Paris (CN2R), Lille, France
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Damas J, Darling KEA, Bidlingmeyer P, Nadin-Debluë I, Bieler M, Vollino L, Sokolov AA, Berney A, Maccaferri G, Filippidis P, Viala B, Granziera C, Dunet V, Du Pasquier R, Cavassini M. One for all, all for one: neuro-HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV. HIV Med 2023. [PMID: 36890672 DOI: 10.1111/hiv.13472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/08/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND With ageing, comorbidities such as neurocognitive impairment increase among people living with HIV (PLWH). However, addressing its multifactorial nature is time-consuming and logistically demanding. We developed a neuro-HIV clinic able to assess these complaints in 8 h using a multidisciplinary approach. METHODS People living with HIV with neurocognitive complaints were referred from outpatient clinics to Lausanne University Hospital. Over 8 h participants underwent formal infectious disease, neurological, neuropsychological and psychiatric evaluations, with opt-out magnetic resonance imaging (MRI) and lumbar puncture. A multidisciplinary panel discussion was performed afterwards, with a final report weighing all findings being produced. RESULTS Between 2011 and 2019, a total of 185 PLWH (median age 54 years) were evaluated. Of these, 37 (27%) had HIV-associated neurocognitive impairment, but they were mainly asymptomatic (24/37, 64.9%). Most participants had non-HIV-associated neurocognitive impairment (NHNCI), and depression was prevalent across all participants (102/185, 79.5%). Executive function was the principal neurocognitive domain affected among both groups (75.5% and 83.8% of participants impaired, respectively). Polyneuropathy was found in 29 (15.7%) participants. Abnormalities in MRI were found in 45/167 participants (26.9%), being more common among NHNCI (35, 77.8%), and HIV-1 RNA viral escape was detected in 16/142 participants (11.2%). Plasma HIV-RNA was detectable in 18.4% out of 185 participants. CONCLUSIONS Cognitive complaints remain an important problem among PLWH. Individual assessment from a general practitioner or HIV specialist is not enough. Our observations show the many layers of HIV management and suggest that a multidisciplinary approach could be helpful in determining non-HIV causes of NCI. A 1-day evaluation system is beneficial for both participants and referring physicians.
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Affiliation(s)
- José Damas
- Department of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Katharine E A Darling
- Department of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Phanie Bidlingmeyer
- Department of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Isaure Nadin-Debluë
- Laboratory of Neuroimmunology, Research Centre of Clinical Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mélanie Bieler
- Department of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lidia Vollino
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Arseny A Sokolov
- Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Berney
- Service of Psychiatry, Department of Liaison Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giorgio Maccaferri
- Adult Psychiatry Service-North and University Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Paraskevas Filippidis
- Department of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Benjamin Viala
- Department of Infectious Diseases, Centre Hospitalier Alpes Léman, Contamine-sur-Avre, France
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Department of Neurology, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2MB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Vincent Dunet
- Department of Medical Radiology, Service of Diagnostic and Interventional Radiology, Neuroradiology Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Renaud Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Cavassini
- Department of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Etesami MS, Saboury N, Mohraz M, SeyedAlinaghi S, Jones DL, Vance DE, Habibi Asgarabad M. Immediate and Long-Term Effects of a Computerized Cognitive Rehabilitation Therapy on Cognitive Function in People Living with HIV in Iran: A Single-Blind Two-Arm Parallel Randomized Controlled Trial. J Assoc Nurses AIDS Care 2022; 33:505-522. [PMID: 35878047 DOI: 10.1097/jnc.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Up to 50% of people with HIV (PWH) experience neurocognitive impairments (NCIs) that can interfere with everyday functioning and reduce quality of life. To address this problem, this study examined the immediate and long-term efficacy of computerized cognitive rehabilitation therapy (CCRT) on cognitive function in PWH in Tehran, Iran. Thirty PWH with NCI engaged in 24 biweekly 90-min CCRT sessions. A control group of 30 PWH and NCI received treatment-as-usual, but no CCRT. The cognitive rehabilitation protocol focused on attention, visual memory, nonverbal learning, and planning. Pretest, posttest, and follow-up cognitive measurements showed that the designed CCRT protocol was effective in improving performance in selected cognitive domains along with the global neurocognitive performance scores of PWH. These findings suggest that this CCRT protocol be considered as part of a treatment plan to address cognitive impairment for PWH. Implications for clinical practice and research are provided.
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Affiliation(s)
- Maede Sadat Etesami
- Maede Sadat Etesami, MSc, is a Clinical Psychologist and Researcher, Iranian Research Center for HIV/AIDS (IRCHA), Imam Khomeini Hospital Complex; Health Promotion Research Center, Iran University of Medical Sciences; Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran. Nadia Saboury, MSc, is a Psychologist, Department of Psychology, Faculty of Humanities, University of Science and Culture, Tehran, Iran. Minoo Mohraz, MD, MPH, is a Professor, Iranian Research Center for HIV/AIDS (IRCHA), Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran, Iran. SeyedAhmad SeyedAlinaghi, MD, PhD, MPhil, is an Associate Professor and Senior Medical Researcher, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. Deborah L. Jones, PhD, is a Professor, Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Mojtaba Habibi Asgarabad, PhD, is an Assistant Professor, Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences; Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran; and Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Wei J, Hou J, Mu T, Sun J, Li S, Wu H, Su B, Zhang T. Evaluation of Computerized Cognitive Training and Cognitive and Daily Function in Patients Living With HIV: A Meta-analysis. JAMA Netw Open 2022; 5:e220970. [PMID: 35238931 PMCID: PMC8895263 DOI: 10.1001/jamanetworkopen.2022.0970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE In the era of antiretroviral therapy (ART), the incidence of HIV-associated neurocognitive disorder (HAND) has not yet been controlled. With the exception of ART, there is no beneficial pharmacologic treatment. However, some studies have reported that computerized cognitive training (CCT) programs may improve cognitive function among people living with HIV. OBJECTIVE To examine the association between CCT programs and 8 domains measuring cognitive function (7 domains) and daily function (1 domain) among people living with HIV. DATA SOURCES Records from the Cochrane Library, PsycINFO, PubMed, and Web of Science were searched from database inception to December 15, 2020. Supplementary searches to identify missing studies were conducted in Google Scholar using updated search terms from database inception to November 18, 2021. STUDY SELECTION Studies that compared changes before and after a CCT intervention among people living with HIV were included. Search terms were a combination of words associated with HIV (eg, people living with HIV, HIV, and/or AIDS) and cognitive training (eg, cognitive intervention, nonpharmacology intervention, computer game, video game, computerized training, cognitive exercise, cognitive stimulation, and/or cognitive enhancement). Studies were included if they (1) used CCT as the primary intervention or combined CCT with other types of interventions; (2) used placebo, passive control conditions, traditional cognitive training, or single training tasks as control conditions; (3) reported changes between baseline and posttraining; (4) included participants 18 years or older; and (5) were randomized clinical trials (RCTs). Studies were excluded if they (1) were not associated with HIV, (2) were research protocols or feedback reports, (3) were case reports, or (4) did not report findings for domains of interest. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Random-effects models were used to quantitatively synthesize the existing data. MAIN OUTCOMES AND MEASURES Primary outcomes were the meta-synthesized changes in each domain after CCT. RESULTS Among 1245 records identified, 1043 were screened after removal of duplicates. Of those, 1019 records were excluded based on titles and abstracts, and 24 full-text articles were assessed for eligibility. After exclusions, 12 eligible RCTs were selected for inclusion in the meta-analysis. These RCTs involved 596 total participants, with 320 individuals in the CCT group (mean age, 47.5-59.7 years; 0%-94% female; 8.3-14.2 years of education) and 276 individuals in the control group (mean age, 44.2-60.0 years; 19%-90% female; 9.0-14.9 years of education). The average HIV inhibition ratio (the proportion of participants who achieved virological suppression) ranged from 30% to 100%, and the CD4+ T-cell count ranged from 471 to 833 cells/μL. The time since training ranged from 3 to 24 weeks. After receipt of CCT, function significantly improved in 6 of the 8 domains: abstraction and executive function (standardized mean difference [SMD], 0.58; 95% CI, 0.26-0.91; P < .001), attention and working memory (SMD, 0.62; 95% CI, 0.33-0.91; P < .001), memory (SMD, 0.59; 95% CI, 0.20-0.97; P = .003), motor skills (SMD, 0.50; 95% CI, 0.24-0.77; P < .001), speed of information processing (SMD, 0.65; 95% CI, 0.37-0.94; P < .001), and daily function (SMD, 0.44; 95% CI, 0.02-0.86; P = .04). Sensory and perceptual skills (SMD, 0.06; 95% CI, -0.36 to 0.48; P = .78) and verbal and language skills (SMD, 0.46; 95% CI, -0.07 to 0.99; P = .09) did not significantly improve after CCT. CONCLUSIONS AND RELEVANCE This meta-analysis of RCTs found that CCT programs were associated with improvements in cognitive and daily function among people living with HIV. Future studies are needed to design optimal specific training programs and use implementation science to enable the transformation of CCT from a scientific research tool to a real-world clinical intervention.
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Affiliation(s)
- Jiaqi Wei
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jianhua Hou
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tingting Mu
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jun Sun
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Shuang Li
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Bin Su
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Nichols SL. Central Nervous System Impact of Perinatally Acquired HIV in Adolescents and Adults: an Update. Curr HIV/AIDS Rep 2022; 19:121-132. [PMID: 35107809 PMCID: PMC8904346 DOI: 10.1007/s11904-021-00598-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/24/2022]
Abstract
Purpose of Review Perinatally acquired HIV infection (PHIV) can confer neurodevelopmental risk. As children with PHIV increasingly survive through adolescence and into adulthood, understanding its long-term central nervous system (CNS) impacts is critical for maximizing adult outcomes and quality of life. Recent Findings Recently published neurocognitive and neuroimaging findings show impacts on the CNS associated with early HIV disease progression that endure into adolescence and young adulthood. Although developmental trajectories in adolescence largely appear stable, further research on maturational processes is indicated. Summary Although early antiretroviral therapy in infancy appears to be protective, it is not universally available and current youth largely developed without its benefit. The neurocognitive effects of HIV and the multiple other risks to neurodevelopment experienced by youth with PHIV call for further longitudinal research and a multifaceted approach to prevention and intervention.
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Affiliation(s)
- Sharon L Nichols
- Department of Neurosciences, University of California, San Diego 9500 Gilman Drive, #0935, CA, 92093, La Jolla, USA.
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Ruiz-Robledillo N, Clement-Carbonell V, Ferrer-Cascales R, Portilla-Tamarit I, Alcocer-Bruno C, Gabaldón-Bravo E. Cognitive Functioning and Its Relationship with Self-Stigma in Men with HIV Who Have Sex with Men: The Mediating Role of Health-Related Quality of Life. Psychol Res Behav Manag 2021; 14:2103-2114. [PMID: 34938135 PMCID: PMC8687686 DOI: 10.2147/prbm.s332494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction The human immunodeficiency virus (HIV) stills remains a serious public health problem. HIV acquisition has several negative health consequences, such as a cognitive deterioration or health-related quality of life (HRQoL) impairment. Although these negative consequences could be directly related to a significant increase in self-stigma in this population, few previous studies have analysed the possible associations between these variables. This is especially the case in specific groups of people living with HIV, such as men who have sex with men who could be at a greater risk of stigmatisation. The main aim of the present study was to evaluate the association between cognitive functioning, HRQoL and self-stigma in a group of men with HIV who have sex with men. Methods The present study was conducted in the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). The final sample was composed of 70 participants who passed the inclusion and exclusion criteria. All were men with HIV who had sex with men and the sample’s mean age was 45 years. Each participant completed questionnaires on HRQoL and HIV self-stigma. Moreover, they completed an online cognitive assessment through the previously validated platform for cognitive evaluation CogniFit, Inc. Results The obtained results showed a significant association between memory functioning impairment, lower levels of HRQoL and higher HIV self-stigma scores. Hence, HRQoL, in the mental summary domain, was shown to be a significant mediator in the relationship between low memory performance and higher HIV self-stigma. Discussion Neurocognitive impairment could decrease HRQoL in men with HIV who have sex with men, and hence, reinforce the idea widespread in society that having HIV holds serious consequences. This fact, together with the reduced cognitive abilities to fight against their own self-stigma could represent plausible explanations of the obtained results. In this sense, intervention strategies, oriented towards reducing cognitive impairment, such as those based on cognitive training, and other psychological interventions to promote HRQoL could be effective approaches to prevent the negative effects of HIV self-stigma in this population.
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Affiliation(s)
- Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | | | - Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Irene Portilla-Tamarit
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Cristian Alcocer-Bruno
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Eva Gabaldón-Bravo
- Department of Nursing, Faculty of Health Science, University of Alicante, Alicante, Spain
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