Predictors of perception of cognitive functioning in HIV/AIDS

Association between HIV duration and symptom distress among middle-aged and elderly people with HIV-infected in China: a cross-sectional study

Background

Debate has persisted regarding whether PLWH with longer HIV durations have lower levels of prevalence and severity of symptoms compared with their newly diagnosed counterparts. Whether and how the HIV duration impact the symptom distress among middle-aged and older PLWH has not been explored clearly.

Methods

The patients with HIV-infected aged more than 40 years old were included from seven designated medical institutions of seven regions in China. Outcome was the score of symptom distress. We used the multiple regression model to calculate adjusted Coefficient of Regression (β) with 95% CI in this study.

Results

Among 210 participants (mean age 50.8 years; 71.0% male; 68.1% at asymptomatic stage) in the study, the median number of symptoms was 5. Of all symptoms reported, the most distressed symptoms were sleep disturbance (33.33%), followed by memory loss (31.90%), fatigue (26.67%), slow reactions (22.86%), and vision blur (21.90%). All participants were divided into four groups according to HIV duration, and the median of total score of symptom ditress among all participants was 0.1(0.0,0.9). Difference of total scores and clusters’ scores of symptom distress among four HIV duration groups were statistically significant. 51 participants with 6–10 years HIV duration were more likely to be higher level of education, at asymptomatic stage and have higher CD4 + T cell count. After adjustment for gender, age, race, education, marital status, employment, family income, region, stage of disease and CD4 + T cell count, the score of symptom distress among participants with 6–10 years HIV duration had was higher with the extension of HIV duration. Specially in physical symptoms and psychological symptoms,participants with 6–10 years HIV duration reported the persisting worse burdensome.

Conclusions

HIV duration with 6–10 yearsmay be a key period that the medical team needs to pay special attention to among middle-aged and elderly PLWH. There is a need to provide medical and psychosocial services targeting middle-aged and elderly PLWH according to their changing symptom distress.

Trial registration

Clinicaltrials.gov: ChiCTR2100046225. Registered 11 May 2021.

HIV-related symptoms and patient clusters among Chileans living with HIV

Identifying both Human immunodeficiency virus (HIV)-related and co-morbid symptoms experienced by people living with HIV (PLWH) who are receiving antiretroviral therapy (ART) treatment is a major challenge for healthcare providers globally. Yet, little research to date has examined the symptoms of illness experienced by PLWH including patients living in Central and South American. To address this gap, this study was designed to identify symptoms of HIV by socio-demographic and/or clinical characteristics among Chilean patients living with the virus. A convenience sample of 209 Chilean PLWH was recruited from an outpatient clinic in Santiago, Chile. A structured interview was used to elicit socio-demographic information and HIV symptoms status. Additional clinical information was obtained through a review of the participants' medical records. Results show that patients' most commonly reported HIV-related symptoms were fear/worries (66%), anxiety (52%), gas/bloating (50%), and thirst (50%). Multivariate analysis revealed a positive association between the number of reported HIV-related symptoms and number of years living with HIV. Having completed college was negatively associated with number of symptoms. Latent class analysis indicated that PLWH in the sample who had completed college were two times more likely to experience a mild intensity of HIV-related symptoms than their lesser educated counterparts. Similarly, logistic regression revealed that college-educated PLWH were twice as likely to be classified in the subgroup reporting mild intensity of symptoms than those who lacked a college degree. Overall, the study's results reveal that many Chilean PLWH, even those with high CD4 counts and low or undetectable viral loads, are not symptom free. The findings point to the need for clinicians to tailor a plan of care for individuals living with HIV that is based on their symptomatology.

Contributors to neuropsychological impairment in HIV-infected and HIV-uninfected opiate-dependent patients

Neuropsychological (NP) impairment is multiply determined among HIV-infected and HIV-uninfected individuals who are also dually diagnosed with depression and who use illicit substances. The purpose of the present study was to assess the impact of HIV status, depression, and problematic substance use on NP performance. A total of 160 opiate-dependent outpatients undergoing methadone maintenance (80 HIV-infected, 80 HIV-uninfected) completed diagnostic and NP evaluations. Raw scores from individual NP tests were converted to Z scores relative to standard norms and were averaged to form a composite score. HIV-infected participants had significantly lower overall NP performance--as well as lower performance on tests of attention, motor speed, and verbal memory--than HIV-uninfected participants. In multiple regression analyses considering the role of depression and substance use, only HIV status emerged as a significant predictor of NP impairment. These findings confirm NP impairment in HIV-infected substance abusing patients independent of comorbid depression and severity of substance use.

Assessing cognitive capacity for participation in a research study

To give informed consent in research, persons must be mentally capable of understanding the study, risks, and benefits. An objective screening tool may assess cognitive capacity better than brief conversations or clinician input. The purpose is to explore the validity of the Mental Alternations Test (MAT) to assess the cognitive capacity of older (ages 50 years +) HIV+ persons (N = 81). Descriptive correlational quantitative method was used. About 12% of the sample was cognitively impaired. Contrary to expectations, primary language was the only variable with a significant relationship with the MAT (r = -.22, p = .02); there were no significant relationships between the MAT and age, education, alcohol, smoking, injection drug use, street or mind-altering drug use, physical functional status, depressive symptoms, comorbidities, or being diagnosed with AIDS. Our findings suggest caution in using the MAT as an instrument for assessing cognitive impairment in a linguistically diverse population.

University of California, San Francisco International Nursing Network for HIV/AIDS Research

AIM

The University of California, San Francisco International Nursing Network for HIV/AIDS Research (the Network) is an international group of nurse scientists dedicated to research and education for the purpose of improving HIV/AIDS nursing care around the world. This article describes the evolution of the Network, as well as its structure, achievements and challenges.

BACKGROUND

Although HIV/AIDS has been around for over 25 years, millions of people are still affected by the disease every year. Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that in 2005, there were 38.6 million people living with HIV around the world. In many parts of the developed and developing world, nurses are the primary caregivers for people living with HIV/AIDS, and they need up-to-date information about the daily management of the disease. The Network was established to respond to the need of HIV/AIDS nurses for relevant information to inform clinical care. The Network's main activity is a series of international multi-site collaborative research studies. Past studies have addressed issues such as medication adherence, symptom management and self-care for people living with HIV/AIDS. The Network also hosts semi-annual meetings as well as a biannual international nursing science conference.

CONCLUSION

The Network's flexible structure has proven to be one of its greatest assets, as well as a challenge. Although the Network faces challenges, it has proven to be a useful framework for conducting international collaborative activities related to HIV/AIDS and nursing science.

Sleep disturbances and psychomotor decline in HIV

Sleep disturbances may contribute to cognitive and psychomotor impairments. 50 HIV-positive and 50 HIV-negative adults were assessed on cognitive performance and sleep hygiene. The HIV-positive group performed more poorly on cognitive measures; however, no group differences were found for the sleep variables. In the HIV-positive group, indicators of sleep disturbance were correlated to various measures of cognitive functioning and depression.

Lipodystrophy-associated symptoms and medication adherence in HIV/AIDS

Lipodystrophy-associated manifestations remain a challenge for persons infected with HIV disease and their care providers. Symptomatic HIV disease and side effects of medications are implicated in antiretroviral medication nonadherence. This study examined the relationship between time since initial diagnosis with HIV, presence and type of lipodystrophic symptoms, and adherence to medication regimens in persons with HIV/AIDS. Using a cross-sectional, descriptive design, the sample was composed of 165 persons from three outpatient HIV settings in Boston, Massachusetts; Fresno, California; and Victoria, Texas. Participants completed a questionnaire comprised of sociodemographic questions, adherence scales, quality-of-life scales, and open-ended questions regarding presence and types of lipodystrophy-associated symptoms, and how these physical changes made them feel. Adherence was moderate with a mean score of 1.44 (standard deviation [SD] +/- 1.33) on the Morisky Medication Adherence Scale (MMAS). The MMAS is a Likert-type scale ranging from 0-4, with "0" indicating very adherent. This finding indicated that the participants took their medications moderately well despite self-reports of significant numbers of HIV disease and treatment-related body fat changes. Time since initial diagnosis was 8.86 +/- 5.55 years and was not related to adherence. Nor did the type of lipodystrophic symptoms affect adherence. Quality of life however, was significantly related to adherence suggesting an approach that might be taken to improve adherence.

Cortical and subcortical dynamics of aging with HIV infection

Given pharmaceutical advancements, more people with HIV will be living to old age. Cognitive declines have been observed both during normal aging and in people with HIV; whether there are cumulative cognitive declines in adults aging with HIV remains unknown. Based on current literature, adults aging with HIV may be at risk for psychomotor declines that resemble parkinsonianism.

A behavioral-medicine program in HIV. Implications for quality of life

The purpose of this descriptive study is to examine quality of life issues in participants in a behavioral-medicine group (N = 24). Of the sample, 60% indicated current use of complementary therapies. Sexual functioning, a subscale of the quality-of-life measure, was positively correlated with length of time with HIV. CD4+ lymphocyte counts were not significantly correlated with quality of life (QOL). Viral load (VL) was positively correlated with the social-support subscale of the QOL scale. Use of body therapies (massage, acupuncture) was associated with social functioning and use of nutritional therapies was associated with mental health. Results of the study indicate that clinical interventions, including behavioral-medicine interventions and complementary therapies for persons with HIV/AIDS, can result in greater QOL.

Validation of a Chinese version of the sign and symptom checklist for persons with HIV diseases

Symptoms are common in HIV-infected persons and occur at all stages of the illness. An effective symptom assessment tool can help health care providers quickly detect patients' problems and provide suitable care. Because no studies focusing on developing a sign and symptom checklist for persons with HIV can be found for Taiwanese patients or for those who speak Chinese, the purpose of this study was to validate a Chinese version of the Sign & Symptom Checklist for Persons with HIV (SSC-HIV-C). The Checklist first was translated from the English version into a Chinese version and then was back translated to examine accuracy. Both face and construct validity were used to examine overall validity of the instrument. Tests for internal consistency and test-retest reliability were used to examine the reliability of the instrument. The results indicated that the Chinese version of the SSC-HIV yielded highly acceptable parameters of validity and reliability. This Chinese version of the SSC-HIV can be used for measuring signs and symptoms of HIV-AIDS in persons in Taiwan who have HIV, as well as for other Chinese-speaking populations.

The revised Sign and Symptom Check-List for HIV (SSC-HIVrev)

Symptom management for persons living with HIV/AIDS is recognized as an extremely important component of care management. This article reports on the continuing validation of the revised Sign and Symptom Check-List for Persons With HIV Disease (SSC-HIVrev). The initial validation study used a combined sample of 933 HIV-positive persons and concluded that the validity and reliability of the instrument were adequate to measure patients' self-report of HIV-related signs and symptoms. The revised scale includes items to measure gynecological-related symptoms and the impact of lipodystrophy (body fat redistribution) due to antiretroviral therapy on patients' symptom experience. The scale structure (factor analysis) and reliability estimates were recalculated in a new sample of 372 HIV-positive persons. Based on reviewing the clusters of items, factor loadings, reliability estimates, and clinical interpretability, an 11-factor solution was determined that explained 73.3% of the variance. Of the retained factors, 4 had eigenvalues less than 1, yet they explained significant amounts of variance in the rotated sums of squares loading (5.0%, 4.3%, 4.3%, and 3.6%, respectively), the reliability estimates were good, and the factors had clinical meaning. The revised scale (SSC-HIVrev) has three parts: Part 1 consists of 45 items that clustered into 11 factor scores along with a total score, with reliability estimates ranging from .76 to .91; Part 2 consists of 19 HIV-related symptoms that do not cluster into factor scores but may be of interest from a clinical perspective; and Part 3 consists of 8 items related to gynecological symptoms for women. These 8 items were submitted to a principal components factor analysis with varimax rotation (n = 118 HIV-positive women), and a 1-factor solution explained 71.8% of the variance, with a reliability estimate of .94. The psychometric properties of the SSC-HIVrev are presented.