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Moore DJ, Sun-Suslow N, Nichol AA, Paolillo EW, Saloner R, Letendre SL, Iudicello J, Morgan EE. The clinical utility of three frailty measures in identifying HIV-associated neurocognitive disorders. AIDS 2024; 38:645-655. [PMID: 38051787 PMCID: PMC10939888 DOI: 10.1097/qad.0000000000003805] [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] [Indexed: 12/07/2023]
Abstract
OBJECTIVE Frailty measures vary widely and the optimal measure for predicting HIV-associated neurocognitive disorders (HAND) is unclear. DESIGN A study was conducted to examine the clinical utility of three widely used frailty measures in identifying HIV-associated neurocognitive disorders. METHODS The study involved 284 people with HIV (PWH) at least 50 years enrolled at UC San Diego's HIV Neurobehavioral Research Program. Frailty measurements included the Fried Phenotype, the Rockwood Frailty Index, and the Veterans Aging Cohort Study (VACS) Index. HAND was diagnosed according to Frascati criteria. ANOVAs examined differences in frailty severity across HAND conditions. ROC analyses evaluated sensitivity and specificity of each measure to detect symptomatic HAND [mild neurocognitive disorder (MND) and HIV-associated dementia (HAD)] from no HAND. RESULTS Across all frailty measures, frailty was found to be higher in HAD compared with no HAND. For Fried and Rockwood (not VACS), frailty was significantly more severe in MND vs. no HAND and in HAD vs. ANI (asymptomatic neurocognitive impairment). For discriminating symptomatic HAND from no HAND, Fried was 37% sensitive and 92% specific, Rockwood was 85% sensitive and 43% specific, and VACS was 58% sensitive and 65% specific. CONCLUSION These findings demonstrate that Fried and Rockwood outperform VACS in predicting HAND. However, ROC analyses suggest none of the indices had adequate predictive validity in detecting HAND. The results indicate that the combined use of the Rockwood and Fried indices may be an appropriate alternative.
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Affiliation(s)
- David J Moore
- Department of Psychiatry, University of California San Diego
| | - Ni Sun-Suslow
- Department of Psychiatry, University of California San Diego
| | | | | | - Rowan Saloner
- Department of Psychiatry, University of California San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego
- Deparment of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Scott L Letendre
- Department of Psychiatry, University of California San Diego
- Department of Medicine
| | | | - Erin E Morgan
- Department of Psychiatry, University of California San Diego
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Turkson S, van Rooij SJ, Powers A, Ofotokun I, Norrholm SD, N. Neigh G, Jovanovic T, Michopoulos V. HIV Interacts with Posttraumatic Stress Disorder to Impact Fear Psychophysiology in Trauma-Exposed Black Women. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:231-241. [PMID: 38523844 PMCID: PMC10960165 DOI: 10.1089/whr.2023.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/26/2024]
Abstract
Background The prevalence of posttraumatic stress disorder (PTSD) among people living with HIV (PLWH) is higher than in the general population and can impact health behaviors. The influence of HIV on PTSD psychophysiology requires further investigation due to implications for the treatment of PTSD in PLWH. Objective Utilizing fear-potentiated startle (FPS), we aimed to interrogate the influence of PTSD and HIV on fear responses. Materials and Methods Women (18-65 years of age) recruited from the Women's Interagency HIV Study in Atlanta, GA (n = 70, 26 without HIV and 44 with HIV), provided informed consent and completed a semistructured interview to assess trauma exposure and PTSD symptom severity. Participants also underwent an FPS paradigm to assess fear acquisition and extinction: Psychophysiological indices that measure how individuals learn new fear and then subsequently attempt to suppress this fear. Results Women with PTSD, who did not have HIV, exhibited a greater startle response compared to women without PTSD or HIV during late acquisition to both the danger cue, reinforced conditioned stimulus (CS+, p = 0.013)), and the safety cue, non-reinforced conditioned stimulus (CS-, p = 0.046)), whereas women living with HIV (WLH) and PTSD demonstrated blunted fear responses compared to women with PTSD only. During extinction, WLH comorbid with PTSD exhibited an increased fear response during the extinction period in comparison to all other groups (p = 0.023). Women without PTSD demonstrated a reduction in the fear response during extinction regardless of HIV status. Conclusion Our findings indicate that HIV further modifies fear psychophysiology in WLH with comorbid PTSD, highlighting the importance of considering HIV status in conjunction with PTSD treatment.
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Affiliation(s)
- Susie Turkson
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sanne J.H. van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Seth D. Norrholm
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | - Gretchen N. Neigh
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory National Primate Research Center, Atlanta, Georgia, USA
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Shah A, Prakash J, Chatterjee K. Language and executive function of clinical stage-1 HIV patients in an industrial scenario: Extent and implication. Ind Psychiatry J 2023; 32:S147-S150. [PMID: 38370933 PMCID: PMC10871429 DOI: 10.4103/ipj.ipj_232_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 07/17/2023] [Accepted: 09/02/2023] [Indexed: 02/20/2024] Open
Abstract
Background Asymptomatic and mild form of the neurocognitive disorder in individuals with human immunodeficiency virus infection is still prevalent and a chief problem worldwide although the severity of the neurocognitive complications is decreasing after the introduction of combined highly active antiretroviral therapy. Aim To study language and executive dysfunction of HIV patients in Clinical Stage 1 in an industrial scenario in Western Maharashtra as compared to healthy controls. Material and Methods The Wisconsin card sorting test and Addenbrooke cognitive scale were done to check for executive function and language, respectively, and compared to age- and gender-matched HIV-negative controls. Results Both the results of the WCST and Addenbrooke cognitive scale showed a decline in scores in the cases as compared to the controls overall. The distribution of cases as per the gender showed no significant difference, whereas there was a significant difference as per the age. Conclusion In asymptomatic HIV patients, there is a decline in executive function and language as compared to the healthy controls. As most of the individuals were employed, there is a need to assess their neurocognitive function regularly as the progress of the illness can be monitored and cognitive training can be advised in these HIV-positive patients, which will not only benefit the individuals but the industrial sector in the long run as well.
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Affiliation(s)
- Ayushma Shah
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Kaushik Chatterjee
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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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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Sergio JP, Kundu R, McIntosh RC, Palmero M, Hegde RR, de Dios MA, Clark US. Synergistic effects of high early-life stress exposure and HIV infection on reaction time variability. Front Psychol 2023; 14:1096266. [PMID: 37139000 PMCID: PMC10150076 DOI: 10.3389/fpsyg.2023.1096266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Addressing comorbidities contributing to cognitive impairment in people living with HIV (PLWH) remains imperative. Prior studies utilizing reaction time intra-individual variability (RT-IIV), a robust behavioral marker of cognitive dysfunction, demonstrate increased cognitive impairment in adults living with HIV who have high early life stress (ELS) exposure relative to those with low-ELS exposure. Yet, it is unknown whether RT-IIV elevations are due to high-ELS alone or both HIV-status and high-ELS. In the current study, we explore the potential additive effects of HIV and high-ELS exposure on RT-IIV to better characterize the independent and combined effects of these factors on RT-IIV among PLWH. We assessed 59 PLWH and 69 HIV-negative healthy control (HC) participants with either low or high ELS on RT-IIV during a working memory task (1-back). We observed a significant interaction between HIV status and ELS exposure on RT-IIV, PLWH who had experienced high ELS demonstrating RT-IIV elevations relative to all other groups. In addition, RT-IIV was significantly associated with ELS exposure in PLWH, but not in the HC group. We also observed associations between RT-IIV and measures of HIV-disease severity (plasma HIV viral load, nadir CD4) among PLWH. Taken as a whole, these findings provide novel evidence of the combined effects of HIV and high-ELS exposure on RT-IIV, and thus suggest HIV-related and ELS-related neural abnormalities may act in an additive or synergistic manner to affect cognition. Such data warrant further investigation into the neurobiological mechanisms associated with HIV and high-ELS exposure that contribute to increased neurocognitive dysfunction among PLWH.
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Affiliation(s)
- Jordan P. Sergio
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Fordham University, New York, NY, United States
| | - Retina Kundu
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Roger C. McIntosh
- Department of Psychology, University of Miami, Miami, FL, United States
| | - Mabel Palmero
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rachal R. Hegde
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marcel A. de Dios
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States
| | - Uraina S. Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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McIntosh RC, Clark US, Cherner M, Cysique LA, Heaton RK, Levin J, Remien RH, Thames A, Moore DJ, Rubin LH. The Evolution of Assessing Central Nervous System Complications in Human Immunodeficiency Virus: Where Do We Go From Here? J Infect Dis 2023; 227:S30-S37. [PMID: 36930636 PMCID: PMC10022716 DOI: 10.1093/infdis/jiac316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
In this fifth decade of the human immunodeficiency virus (HIV) epidemic, central nervous system (CNS) complications including cognitive impairment and mental health remain a burden for people with HIV (PWH) on antiretroviral therapy. Despite the persistence of these complications, which often co-occur, the underlying pathophysiology remains elusive and consequently treatments remain limited. To continue to grow our understanding of the underlying mechanisms of CNS complications among PWH, there is a need to reexamine our current approaches, which are now more than 2 decades old. At the 2021 National Institutes of Health-sponsored meeting on Biotypes of CNS Complications in PWH, the Neurobehavioral Working Group addressed the following: (1) challenges inherent to determining CNS complications; (2) heterogeneity in CNS complications; and (3) problems and solutions for examining integrated biotypes. The review below provides a summary of the main points presented and discussed by the Neurobehavioral Working Group at the meeting.
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Affiliation(s)
- Roger C McIntosh
- Department of Psychology, University of Miami, Miami, Florida, USA
| | - Uraina S Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Lucette A Cysique
- Department of Psychology, University of New South Wales, Sydney, Australia
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Jules Levin
- National AIDS Treatment Advocacy Project, New York, New York, USA
| | - Robert H Remien
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - April Thames
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Leah H Rubin
- Departments of Neurology, Psychiatry and Behavioral Sciences, Epidemiology, and Molecular and Comparative Pathology, Johns Hopkins University, Baltimore, Maryland, USA
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Spies G, Deist M, Suliman S, Seedat S. Screening for HIV-associated neurocognitive impairment: Development and validation of an abbreviated neuropsychological test battery for use in South African clinical settings. Neuropsychology 2023; 37:166-180. [PMID: 36442008 PMCID: PMC9992844 DOI: 10.1037/neu0000872] [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] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The HIV Neurobehavioral Research Center International Neurobehavioral Battery is a culturally valid battery sensitive to the neurocognitive (NC) effects of HIV-infection. However, its lengthy administration time makes the battery impractical in resource-limited settings, like South Africa, which are often faced with an overwhelming disease burden, a lack of neurological and neuropsychological (NP) expertise, and staff shortages. The present study therefore sought to develop an abbreviated version of the HNRC Battery and validate this battery in a sample of people with HIV (PWH) in South Africa. OBJECTIVE The present study therefore sought to develop an abbreviated version of the HNRC battery and validate this battery in a sample of people with HIV (PWH) in South Africa. METHOD Six measures were selected based on the NC test performances of 103 HIV-positive and 135 HIV-negative South African adults. For the validation, a subgroup of 103 PWH completed the full version of the battery, while the other subgroup of 52 PWH completed only the abbreviated version. Deficit scores of each participant were calculated. These scores were used as the gold standard against which the abbreviated battery was compared. RESULTS There was a reduction of 81% in administration time when compared to the full version of the battery. The abbreviated battery demonstrated good sensitivity (75.0%) and excellent specificity (94.9%) when compared with the full version. The abbreviated battery showed good diagnostic accuracy in identifying NC impairment in an HIV-positive South African sample with a significant reduction in administration time, making it a more practical option in busy South African clinic settings. CONCLUSION The results of this study may facilitate the growth of neuroAIDS research and aid initial identification of HIV-related NC impairment in resource-constrained settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Georgina Spies
- NRF/DSI South African Research Chair in PTSD (SARChI), Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- SAMRC Genomics of Brain Disorders Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Melanie Deist
- NRF/DSI South African Research Chair in PTSD (SARChI), Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Sharain Suliman
- NRF/DSI South African Research Chair in PTSD (SARChI), Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- NRF/DSI South African Research Chair in PTSD (SARChI), Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- SAMRC Genomics of Brain Disorders Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Bernard C, Font H, Diallo Z, Ahonon R, Tine JM, Abouo FN, Tanon A, Messou E, Seydi M, Dabis F, Dartigues JF, de Rekeneire N. Factors associated with verbal fluency in older adults living with HIV in West Africa: A longitudinal study. Trop Med Int Health 2023; 28:35-42. [PMID: 36398852 PMCID: PMC9812871 DOI: 10.1111/tmi.13830] [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: 11/19/2022]
Abstract
OBJECTIVE Verbal fluency decline, observed both in aging and HIV infection, has been related to lower quality of life. This study aimed to evaluate the factors associated with categorical fluency in people living with HIV (PLHIV) aged ≥60 years living in West Africa. METHODS In this longitudinal study, PLHIV aged ≥60 years, on antiretroviral therapy (ART) for ≥6 months were included in three clinics (two in Côte d'Ivoire, one in Senegal) participating in the West Africa International epidemiological Databases to Evaluate AIDS (IeDEA) collaboration. Categorical fluency was evaluated with the Isaacs Set Test at 60 s at baseline and 2 years later. Factors associated with verbal fluency baseline performance and annual rates of changes were evaluated using multivariate linear regression models. RESULTS Ninety-seven PLHIV were included with 41 of them (42%) having a 2-year follow-up visit. The median age was 64 (62-67), 45.4% were female, and 89.7% had an undetectable viral load. The median annual change in categorical fluency scores was -0.9 (IQR: -2.7 to 1.8). Low baseline categorical fluency performance and its decline were associated with older age and being a female. Low educational level was associated with low baseline categorical fluency performance but not with its decline. Categorical fluency decline was also associated with marital status and hypertension. CONCLUSIONS Among older West African PLHIV, usual socio-demographic variables and hypertension were the main factors associated with low categorical fluency performance and/or its decline. Interventions that focus on supporting cardiometabolic health are highly recommended to prevent cognitive disorders in PLHIV.
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Affiliation(s)
- Charlotte Bernard
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Hélène Font
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Zélica Diallo
- Service des maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d'Ivoire
| | - Richard Ahonon
- Centre de prise en charge de recherche et de formation (CePReF), Yopougon Attié Hospital, Abidjan, Côte d'Ivoire
| | | | | | - Aristophane Tanon
- Service des maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Centre de prise en charge de recherche et de formation (CePReF), Yopougon Attié Hospital, Abidjan, Côte d'Ivoire
| | - Moussa Seydi
- Service des maladies infectieuses et tropicales, CHNU de Fann, Dakar, Senegal
| | - François Dabis
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Jean-François Dartigues
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
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Charumbira MY, Berner K, Louw QA. Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15636. [PMID: 36497710 PMCID: PMC9735592 DOI: 10.3390/ijerph192315636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 05/05/2023]
Abstract
A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aimed to systematically identify and map the most common functioning problems associated with health conditions that contribute most to disability in South Africa using the International Classification of Functioning, Disability and Health (ICF) framework. Peer-reviewed evidence published from January 2006 to December 2021 was systematically searched from five databases. Some 268 studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African adults (>18 years) related to 10 health conditions were included. A total of 130 different functioning problems were mapped to the ICF. The most prevalent problems (top 20) were related to mobility, pain, and mental health but spanned across several ICF domains and were mostly in patients at primary care. The high prevalence and wide range of functioning problems may be particularly burdensome on an already strained primary health care (PHC) system. This points towards targeted planning of innovative strategies towards strengthening rehabilitation service delivery at primary care to address these complexities where there is an inadequate rehabilitation workforce.
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Affiliation(s)
- Maria Y. Charumbira
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, South Africa
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McIntosh EC, Beam C, Spahr CM, Slavich GM, Thames AD. Prefrontal Cortex Volume Mediates the Relationship Between Lifetime Chronic Stressor Exposure and Cognition in People Living With and Without HIV. Psychosom Med 2022; 84:904-913. [PMID: 35980777 PMCID: PMC9553266 DOI: 10.1097/psy.0000000000001125] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite considerable research documenting how stress affects brain and neurobehavioral outcomes, few studies have assessed stressor exposure occurring over the entire life span, and no studies have investigated these associations in people living with HIV (PLWH), despite the high stress and disease burden experienced by this population. To address this issue, we examined how cumulative lifetime chronic stressor exposure related to cognition and brain integrity (i.e., gray matter volume) in White and African American PLWH and HIV-uninfected (HIV-) adults. METHOD Participants were 91 community-dwelling adults (47.3% PLWH) who completed a comprehensive interview assessing lifetime stressor exposure using the Stress and Adversity Inventory and underwent neuropsychological testing and structural magnetic resonance imaging. Regional brain volumes were derived from T1-weighted images processed through Freesurfer. RESULTS As hypothesized, greater lifetime chronic stressor exposure was related to worse global cognition ( b = -0.06, standard error [SE] = 0.03, p = .032), processing speed ( b = -0.04, SE = 0.14, p = .041), and executive functioning ( b = -0.06, SE = 0.02, p = .02), and smaller prefrontal cortex (PFC) volume ( b = -16.20, SE = 5.78, p = .007). HIV status did not moderate any of these associations. Moreover, results from mediation analyses demonstrated that the relationship between lifetime chronic stressor exposure and processing speed was fully mediated by PFC volume. CONCLUSIONS These results highlight the critical role of the PFC in the maintenance of processing speed abilities and its vulnerability to cumulative stressor exposure. Specifically, the negative impact of lifetime chronic stressor exposure on cognition-particularly functions reliant on frontal lobe integrity-may be partly driven by smaller volumes in the PFC.
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Roomaney AA, Womersley JS, Swart PC, Spies G, Seedat S, Hemmings SMJ. Childhood trauma and genetic variation in the DAT 40-bp VNTR contribute to HIV-associated neurocognitive disorders. IBRO Neurosci Rep 2022; 12:45-54. [PMID: 35746967 PMCID: PMC9210473 DOI: 10.1016/j.ibneur.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 12/03/2022] Open
Abstract
HIV/AIDS is a major public health burden in South Africa, currently affecting an estimated 13.5% of the population. Despite improved access to antiretroviral therapies, HIV-associated neurocognitive disorders (HAND), characterised by a spectrum of neurocognitive impairment, emotional disturbances and motor abnormalities, continue to persist. Gene-environment interactions contribute to HAND pathophysiology and previous research has identified childhood trauma as an environmental risk factor. Dopaminergic signalling in the prefrontal cortex plays a key role in cognitive function. Thus, variants in genes encoding the dopamine transporter (DAT) and catechol-O-methyltransferase (COMT), which are responsible for dopamine transport and metabolism, could represent genetic risk factors for HAND. This study investigated whether the DAT variable number of tandem repeats (VNTR) and COMT Val158Met (rs4680) polymorphisms are associated with longitudinal change in cognitive function in the context of childhood trauma and HIV. Participants (n = 49 HIV-negative and n = 64 HIV-positive women) completed the Childhood Trauma Questionnaire - Short Form (CTQ-SF) and provided blood for genetic analyses. Global cognitive scores were generated from baseline and one-year follow-up assessments. Following polymerase chain reaction, genotypes were determined using gel electrophoresis and confirmed by Sanger sequencing. Baseline global cognitive scores, genotype, HIV status and CTQ-SF scores were regressed on one-year global cognitive scores in regression models. Analysis of variance was used to examine the effect of including predictor variable interactions on model fit. HIV seropositivity was associated with poorer cognitive performance at one-year follow-up (p = 2.46 ×10-4). The combination of HIV and DAT 10-repeat homozygosity (DAT 10/10) was associated with reduced global cognitive scores in longitudinal models (p = 0.010). Including the interaction between DAT 10/10, childhood trauma, and HIV explained significantly more of the variance in longitudinal cognitive scores (p = 0.008). There were no significant associations with the COMT genotype. Our research indicates that childhood trauma and genetic variation in DAT contribute toward the aetiology of HAND. Future studies in larger cohorts are warranted to verify these results.
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Affiliation(s)
- Aqeedah Abbas Roomaney
- Division of Molecular and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jacqueline Samantha Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Patricia Cathryn Swart
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Georgina Spies
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Research Chair in PTSD, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sian Megan Joanna Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
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12
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Jaff NG, Crowther NJ. The Association of Reproductive Aging with Cognitive Function in Sub-Saharan African Women. Methods Mol Biol 2022; 2343:71-91. [PMID: 34473316 DOI: 10.1007/978-1-0716-1558-4_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Life expectancy in sub-Saharan African women is increasing, and by the late 2020s an estimated 76% of postmenopausal women globally will be living in developing countries. Menopause transition has been associated with cognitive decline in a wide range of studies, but data on cognition and reproductive aging are lacking in sub-Saharan African women. Approximately 72 million people in the region are expected to suffer from dementias and neurocognitive decline by 2050. Studies show that compromised cognitive health in low-income countries has significant implications for adult quality of life and socioeconomic development. There is now an urgent need to further examine risk factors for cognitive decline in these aging women and to understand the ability of public health programs to diagnose and treat cognitive dysfunction. This review examines studies assessing cognition and aging in sub-Saharan African adults, while addressing the significant research gaps. It examines data on the association of the menopause transition with cognitive function and describes how validated tools should be available to assess both menopausal stage and symptoms. Culturally appropriate and validated neurocognitive measures are required to better understand the relationship of reproductive aging with cognition. Longitudinal population-based studies are needed to assess the effect of lifestyle interventions, such as diet and exercise, on cognitive health in sub-Saharan African populations, with an emphasis on women as they transition into menopause.
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Affiliation(s)
- Nicole G Jaff
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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13
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Spies G, Ahmed-Leitao F, Hoddinott G, Seedat S. Effects of unhealthy alcohol use on brain morphometry and neurocognitive function among people with HIV. J Neurovirol 2021; 28:35-45. [PMID: 34882280 DOI: 10.1007/s13365-021-01027-2] [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: 08/24/2021] [Revised: 10/13/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Individual impacts of alcohol misuse and HIV on brain structure and function have been well demonstrated; however, the potential compounded effect of these conditions is seldom considered, despite the high prevalence of alcohol use in HIV infection. We aimed to determine the effects of unhealthy alcohol use on brain morphometry and cognitive function amongst people with HIV (PWH). In 27 (50.9%) HIV-positive users of alcohol and 26 (49.1%) HIV-positive abstainers from alcohol, results revealed significant differences for left and right amygdala (p < 0.01), left and right hippocampus (p = 0.05), left and right posterior cingulate (p < 0.01), left and right precuneus (p < 0.01), left insula (p < 0.01), left and right caudate (p < 0.01), right thalamus (p < 0.01), and corpus callosum (p < 0.05). Mean volume of these regions was significantly smaller in HIV-positive alcohol users compared to HIV-positive abstainers. Homogeneity of slopes ANCOVA revealed significant associations between anterior cingulate cortex, precuneus, amygdala, hippocampus, and insula volumes and cognitive function in the domains of learning and delayed recall, motor function, speed of information processing, executive function, attention/working memory, and language. Among PWH, unhealthy alcohol use is associated with negative effects on brain structure and cognitive function.
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Affiliation(s)
- Georgina Spies
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. .,Department of Psychiatry, South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
| | - Fatima Ahmed-Leitao
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Soraya Seedat
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Department of Psychiatry, South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
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14
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Womersley JS, Spies G, Tromp G, Seedat S, Hemmings SMJ. Longitudinal telomere length profile does not reflect HIV and childhood trauma impacts on cognitive function in South African women. J Neurovirol 2021; 27:735-749. [PMID: 34448146 PMCID: PMC8602727 DOI: 10.1007/s13365-021-01009-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 07/12/2021] [Accepted: 08/03/2021] [Indexed: 12/17/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) present a challenge in South Africa where the burden of HIV infection is the highest. Identification of biological correlates of HAND is required to improve diagnosis and inform interventions. Telomeres maintain genomic integrity and their shortening is a marker of biological aging sensitive to environmental influences. This study examined relative telomere length (rTL) as a predictor of cognitive function in the context of HIV and childhood trauma (CT), a risk factor for HAND. Two hundred and eighty-six women completed a neurocognitive assessment battery and the Childhood Trauma Questionnaire-Short Form (CTQ). Quantitative polymerase chain reaction for amplification of telomeric repeats and the reference gene human beta-globin was used to calculate rTL. Neurocognitive and rTL assessments were repeated at 1 year in 110 participants. Cross-sectional and longitudinal data were assessed using linear and mixed models, respectively. Participants with HIV (n = 135 in cross-sectional and n = 62 in longitudinal study groups) reported more severe CT and had shorter baseline rTL compared to seronegative controls. Participants without HIV had a greater 1-year decline in rTL. Global cognitive and attention/working memory scores declined in participants with HIV. Our data indicate that baseline rTL in the context of CT and HIV did not predict decline in cognitive scores. HIV-associated pathophysiological processes driving cognitive decline may also engage mechanisms that protect against telomere shortening. The results highlight the importance of examining biological correlates in longitudinal studies.
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Affiliation(s)
- Jacqueline Samantha Womersley
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Georgina Spies
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gerard Tromp
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine & Health Sciences, Bioinformatics Unit, South African Tuberculosis Bioinformatics Initiative, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Centre for Bioinformatics and Computational Biology, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sian Megan Joanna Hemmings
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
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15
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Kamkwalala AR, Maki PM, Langenecker SA, Phan KL, Weber KM, Rubin LH. Sex-specific effects of low-dose hydrocortisone on threat detection in HIV. J Neurovirol 2021; 27:716-726. [PMID: 34559394 PMCID: PMC10478032 DOI: 10.1007/s13365-021-01007-6] [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: 05/12/2021] [Revised: 07/15/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
One sex differences in the perception of emotion is that females, particularly those with high anxiety, often show heightened identification of fearful faces. To better understand the causal role of glucocorticoids in this sex difference, we examine these associations in people with HIV(PWH) where emotion perception is impaired and mental health disorders are frequent. In a double-blind, placebo-controlled, cross-over study, we used a single low-dose of hydrocortisone (10 mg; LDH) as a mechanistic probe of the effects of elevated glucocorticoids on negative emotion perception in 65 PWH (31 women). The primary outcome was accuracy in identifying emotional expressions on the Facial Emotion Perception Test (FEPT). Salivary cortisol, self-reported stress/anxiety, and childhood trauma were also assessed. LDH increased salivary cortisol levels versus placebo. The effect of LDH versus placebo on FEPT accuracy depended on the combined influence of facial expression and sex (P = 0.03). LDH influenced accuracy only for women (P = 0.03), specifically for fearful faces (Cohen's d = 0.44, P = 0.04). Women's enhanced threat detection varied with psychological burden (mood, anxiety, and post-traumatic stress symptoms), more pronounced among those with lower burden and trauma (P < 0.05). This result suggests a role of the HPA axis in sex differences for perception of fearful faces in women with HIV, potentially due to changes in glucocorticoid receptor availability/activity, or improved integration of signals from facial recognition and emotion processing regions. The blunting of this effect in men and in individuals with more severe trauma suggests that the mechanisms underlying threat detection differ by sex and trauma history and warrant further investigation.
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Affiliation(s)
- Asante R Kamkwalala
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 6-113a, Baltimore, MD, 21287, USA
| | - Pauline M Maki
- Departments of Psychiatry, Psychology, and OB/GYN University of Illinois At Chicago, IL, Chicago, USA
| | | | - K Luan Phan
- Department of Psychiatry, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 6-113a, Baltimore, MD, 21287, USA.
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
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16
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Neuropsychiatric Disorders, Emotional Disturbances, and Their Associations with HIV-Associated Neurocognitive Disorder. Curr Top Behav Neurosci 2021; 50:347-366. [PMID: 34081306 DOI: 10.1007/7854_2021_233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current chapter provides a critical and narrative review of recent research on the neuropsychiatric disorders, emotional disturbances, and their associations with neurocognitive functioning in people living with HIV infection. We review a range of neuropsychiatric disorders including depression and anxiety disorders, but also emotional disturbances, which can be partly distinguished from depression and anxiety (apathy, alexithymia, and emotional processing impairment). While reviewing the research into the neuropsychiatric disorders and HIV-associated neurocognitive disorders, we also cover the questions of self-reported cognitive symptoms evaluation and interpretation. The chapter includes research on the role of coping skills, perceived stress and response to stressful life events, and connections to neurocognitive impairment in people living with HIV. Promising non-pharmacological interventions are highlighted. The chapter concludes with the clinical implications on how to best consider neuropsychiatric disorders and cognitive symptoms for the diagnosis of HIV-associated neurocognitive disorders, as well as future research directions.
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17
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Denckla CA, Lee SY, Kim R, Spies G, Vasterling JJ, Subramanian SV, Seedat S. Patterning of individual variability in neurocognitive health among South African women exposed to childhood maltreatment. Sci Rep 2021; 11:6669. [PMID: 33758246 PMCID: PMC7988062 DOI: 10.1038/s41598-021-85979-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/09/2021] [Indexed: 11/08/2022] Open
Abstract
There are individual differences in health outcomes following exposure to childhood maltreatment, yet constant individual variance is often assumed in analyses. Among 286 Black, South African women, the association between childhood maltreatment and neurocognitive health, defined here as neurocognitive performance (NP), was first estimated assuming constant variance. Then, without assuming constant variance, we applied Goldstein's method (Encyclopedia of statistics in behavioral science, Wiley, 2005) to model "complex level-1 variation" in NP as a function of childhood maltreatment. Mean performance in some tests of information processing speed (Digit-symbol, Stroop Word, and Stroop Color) lowered with increasing severity of childhood maltreatment, without evidence of significant individual variation. Conversely, we found significant individual variation by severity of childhood maltreatment in tests of information processing speed (Trail Making Test) and executive function (Color Trails 2 and Stroop Color-Word), in the absence of mean differences. Exploratory results suggest that the presence of individual-level heterogeneity in neurocognitive performance among women exposed to childhood maltreatment warrants further exploration. The methods presented here may be used in a person-centered framework to better understand vulnerability to the toxic neurocognitive effects of childhood maltreatment at the individual level, ultimately informing personalized prevention and treatment.
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Affiliation(s)
- Christy A Denckla
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Sun Yeop Lee
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Georgina Spies
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
| | | | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, 02138, USA
| | - Soraya Seedat
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
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18
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Effect of HIV and Interpersonal Trauma on Cortical Thickness, Cognition, and Daily Functioning. J Acquir Immune Defic Syndr 2021; 84:405-413. [PMID: 32235173 DOI: 10.1097/qai.0000000000002358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Interpersonal trauma (IPT) is highly prevalent among HIV-positive (HIV+) individuals, but its relationship with brain morphology and function is poorly understood. SETTING This cross-sectional analysis evaluated the associations of IPT with cognitive task performance, daily functioning, magnetic resonance imaging (MRI) brain cortical thickness, and bilateral volumes of 4 selected basal ganglia regions in a US-based cohort of aviremic HIV+ individuals, with (HIV+ IPT+) and without IPT exposure (HIV+ IPT-), and sociodemographically matched HIV-negative controls with (HIV- IPT+) and without IPT exposure (HIV- IPT-). METHODS Enrollees completed brain MRI scans, a semistructured psychiatric interview, a neurocognitive battery, and 3 measures of daily functioning. Demographic and clinical characteristics of the 4 groups were described, and pairwise between-group comparisons performed using χ tests, analysis of variance, or t-tests. Linear or Poisson regressions evaluated relationships between group status and the outcomes of interest, in 6 pairwise comparisons, using Bonferroni correction for statistical significance. RESULTS Among 187 participants (mean age 50.0 years, 63% male, 64% non-white), 102 were HIV+ IPT+, 35 were HIV+ IPT-, 26 were HIV- IPT-, and 24 were HIV- IPT+. Compared with the remaining 3 groups, the HIV+ IPT+ group had more activities of daily living declines, higher number of impaired Patient's Assessment of Own Functioning Inventory scores, and lower cortical thickness in multiple cerebral regions. Attention/working memory test performances were significantly better in HIV- IPT- compared with the HIV+ IPT+ and HIV+ IPT- groups. Basal ganglia MRI volumes were not significantly different in any between-group comparisons. CONCLUSION IPT exposure and HIV infection have a synergistic effect on daily functioning and cortical thickness in aviremic HIV+ individuals.
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19
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Kamkwalala AR, Wang K, O’Halloran J, Williams DW, Dastgheyb R, Fitzgerald KC, Spence AB, Maki PM, Gustafson DR, Milam J, Sharma A, Weber KM, Adimora AA, Ofotokun I, Sheth AN, Lahiri CD, Fischl MA, Konkle-Parker D, Xu Y, Rubin LH. Starting or Switching to an Integrase Inhibitor-Based Regimen Affects PTSD Symptoms in Women with HIV. AIDS Behav 2021; 25:225-236. [PMID: 32638219 PMCID: PMC7948485 DOI: 10.1007/s10461-020-02967-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As the use of Integrase inhibitor (INSTI)-class antiretroviral medications becomes more common to maintain long-term viral suppression, early reports suggest the potential for CNS side-effects when starting or switching to an INSTI-based regimen. In a population already at higher risk for developing mood and anxiety disorders, these drugs may have significant effects on PTSD scale symptom scores, particularly in women with HIV (WWH). A total of 551 participants were included after completing ≥ 1 WIHS study visits before and after starting/switching to an INSTI-based ART regimen. Of these, 14% were ART naïve, the remainder switched from primarily a protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. Using multivariable linear mixed effects models, we compared PTSD Civilian Checklist subscale scores before and after a "start/switch" to dolutegravir (DTG), raltegravir (RAL), or elvitegravir (EVG). Start/switch to EVG improved re-experiencing subscale symptoms (P's < 0.05). Switching to EVG improved symptoms of avoidance (P = 0.01). Starting RAL improved arousal subscale symptoms (P = 0.03); however, switching to RAL worsened re-experiencing subscale symptoms (P < 0.005). Starting DTG worsened avoidance subscale symptoms (P = 0.03), whereas switching to DTG did not change subscale or overall PTSD symptoms (P's > 0.08). In WWH, an EVG-based ART regimen is associated with improved PTSD symptoms, in both treatment naïve patients and those switching from other ART. While a RAL-based regimen was associated with better PTSD symptoms than in treatment naïve patients, switching onto a RAL-based regimen was associated with worse PTSD symptoms. DTG-based regimens either did not affect, or worsened symptoms, in both naïve and switch patients. Further studies are needed to determine mechanisms underlying differential effects of EVG, RAL and DTG on stress symptoms in WWH.
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Affiliation(s)
- Asante R. Kamkwalala
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
| | - Jane O’Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Dionna W. Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Amanda B. Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC
| | - Pauline M. Maki
- Departments of Psychiatry, Psychology and OB/GYN, University of Illinois at Chicago, Chicago, IL
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California
| | | | - Kathleen M. Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Anandi N. Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Cecile D. Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Yanxun Xu
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO,Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
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20
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Spies G, Mall S, Wieler H, Masilela L, Castelon Konkiewitz E, Seedat S. The relationship between potentially traumatic or stressful events, HIV infection and neurocognitive impairment (NCI): a systematic review of observational epidemiological studies. Eur J Psychotraumatol 2020; 11:1781432. [PMID: 33029322 PMCID: PMC7473036 DOI: 10.1080/20008198.2020.1781432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND HIV/AIDS and potentially traumatic events (PTEs) or stressful life events (SLEs) and/or PTSD are independently associated with neurocognitive impairment (NCI). Literature suggests that HIV and PTE/SLE exposure independently and consistently affect various domains of cognition including language ability, working memory and psychomotor speed. There are limited data on the interaction between HIV infection and PTEs and their combined effect on NCI. OBJECTIVE In this systematic review, we synthesise evidence for the combined effect of HIV infection and PTEs and SLEs and/or post-traumatic stress disorder (PTSD) on NCI of people living with HIV/AIDS (PLWHA) from high-, middle- and low- income countries. METHOD Our inclusion criteria were observational epidemiological studies (case-control, cohort and cross-sectional designs) that investigated the interaction of HIV infection, PTEs and SLEs and/or PTSD and specifically their combined effect on NCI in adults. We searched a number of electronic databases including Pubmed/Medline, PsycINFO, Scopus and Global Health using the search terms: cognition, HIV/AIDS, observational studies, trauma and permutations thereof. RESULTS Fifteen studies were included in the review, of which the majority were conducted in high-income countries. Ten of the fifteen studies were conducted in the United States of America (USA) and five in South Africa. Seven of these focused on early life stress/childhood trauma. The remaining studies assessed adult-onset PTEs and SLEs only. Eight studies included women only. Overall, the studies suggest that PTE and SLE exposure and/or PTSD are a significant risk factor for NCI in adults living with HIV, with impairments in memory and executive functions being the most likely consequence of PTE and SLE exposure. CONCLUSION These findings highlight the need for trauma screening and for the integration of trauma-focused interventions in HIV care to improve outcomes.
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Affiliation(s)
- G. Spies
- DST/NRF South African Research Chair in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - S. Mall
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - H. Wieler
- DST/NRF South African Research Chair in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - L. Masilela
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - E. Castelon Konkiewitz
- Faculdade de Ciências Médicas e da Saúde, Universidade Federal da Grande Dourados, Dourados, Brasil
| | - S. Seedat
- DST/NRF South African Research Chair in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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21
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Cultural Neuropsychology Considerations in the Diagnosis of HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci 2020; 50:193-223. [PMID: 32157665 DOI: 10.1007/7854_2019_121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Human Immunodeficiency Virus Type-I (HIV) is a health disparities issue that affects culturally and linguistically diverse (CALD) and underrepresented minority populations to a greater degree than non-Hispanic white populations. Neurologically speaking, CALD populations experience worse HIV-related health outcomes, which are exacerbated by inadequate neurocognitive measures, poor normative samples, and the complex interplay of sociocultural factors that may affect test interpretation. Although cross-cultural neuropsychologists are working diligently to correct this gap in the literature, currently, studies examining neurocognitive outcomes among CALD populations are sparse. The most well-studied CALD groups are of African American/Black and Latinx adults in the US, and the chapter therefore focuses on these studies. There is more limited work among other populations in the US, such as Asians, Native Hawaiians, Pacific Islanders, and American Indians/Alaskan Natives, and even fewer studies for many CALD populations outside of the US. For example, HIV neuropsychology data is rare or nonexistent in the First Peoples of Australia and Indigenous People of Canada. It is often not adequately reported in Europe for the migrant populations within those countries or other world regions that have historically large multicultural populations (e.g., South America, Caribbean countries, Asia, and Africa). Therefore, this chapter reviews HIV-related health disparities faced by CALD populations with focus on North American research where it has been specifically studied, with particular attention given to disparities in HIV-Associated Neurocognitive Disorders (HAND). International data was also included for research with focus on First Peoples of Australia and Indigenous People of Canada. The chapter also examines other sociocultural and health factors, including global and regional (e.g., rural versus urban) considerations, migration, and gender. Further, guidelines for incorporating sociocultural consideration into assessment and interpretation of neurocognitive data and HAND diagnosis when working with HIV-positive CALD populations that would be relevant internationally are provided.
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Halpin SN, Ge L, Mehta CC, Gustafson D, Robertson KR, Rubin LH, Sharma A, Vance D, Valcour V, Waldrop-Valverde D, Ofotokun I. Psychosocial Resources and Emotions in Women Living With HIV Who Have Cognitive Impairment: Applying the Socio-Emotional Adaptation Theory. Res Theory Nurs Pract 2020; 34:49-64. [PMID: 31937636 PMCID: PMC8062986 DOI: 10.1891/1541-6577.34.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Decreased cognitive function is related to undesirable psychological outcomes such as greater emotional distress and lower quality of life, particularly among women living with HIV who experience cognitive impairment (WLWH-CI). Yet, few studies have examined the psychosocial resources that may attenuate these negative emotional outcomes. The current study sought to identify the interrelated contributions of social relationships and psychological resources in 399 WLWH-CI by applying Socio-Emotional Adaptation (SEA) theory using data from the Women's Interagency HIV Study (WIHS). Cognitive impairment (CI) was defined as impairment on two or more cognitive domains. Logistic regression models were used to estimate the odds of experiencing specific emotions due to a combination of four psychosocial resources. Emotions (i.e., depression, apathy, fear, anger, and acceptance) were related to a combination of binary (positive/negative) psychosocial resources including relationship with an informal support partner, relationship with a formal caregiver, coping, and perceived control. Understanding the conditions that may influence emotions in WLWH-CI is important for identifying and appropriately addressing the needs of this population. As CI increases, these individuals experience increasing challenges with articulating their care needs and having their needs met. As such, it becomes increasingly important to identify possible triggers for emotional responses to best address these underlying challenges.
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Affiliation(s)
| | - Lin Ge
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Christina C Mehta
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | | | - Kevin R Robertson
- AIDS Neurological Center, Department of Neurology.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leah H Rubin
- Departments of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Anjali Sharma
- Albert Einstein College of Medicine, Yeshiva University, New York, NY
| | - David Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Victor Valcour
- Global Brain Health Institute, San Franscisco, CA.,Department of Neurology, University of California San Fransisco, San Fransisco, CA
| | | | - Igho Ofotokun
- Emory University School of Medicine, Division of Infectious Disease, Atlanta, GA
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23
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Womersley JS, Clauss LB, Varathan O, Engelbrecht S, Hemmings SMJ, Seedat S, Spies G. The effect of childhood trauma, ApoE genotype and HIV-1 viral protein R variants on change in cognitive performance. BMC Res Notes 2019; 12:828. [PMID: 31881924 PMCID: PMC6935155 DOI: 10.1186/s13104-019-4869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 12/19/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Gene-environment interactions contribute to the development of HIV-associated neurocognitive disorders. We examined whether childhood trauma, apolipoprotein E isoforms and viral protein R (Vpr) variants were associated with change in cognitive performance. Seventy-three seropositive women completed neuropsychological assessments at baseline and 1-year follow-up. We conducted genetic analyses using DNA obtained from blood and calculated risk scores based on Vpr amino acid 37, 41 and 55 variants that were previously associated with cognitive performance. RESULTS Global cognitive scores declined significantly over the 1-year study period (p = 0.029). A reduction in global cognitive scores was associated with childhood trauma experience (p = 0.039).
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Affiliation(s)
- Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Lara B Clauss
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
- Joint Master in Neuroscience, Faculty of Life Sciences, University of Strasbourg, Strasbourg, France
| | - Olivette Varathan
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Susan Engelbrecht
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
- National Health Laboratory Services (NHLS), Tygerberg Coastal, Tygerberg, Western Cape Region, South Africa
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Georgina Spies
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Francie van Zijl Drive, Tygerberg, 7505, South Africa
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24
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Rubin LH, Neigh GN, Sundermann EE, Xu Y, Scully EP, Maki PM. Sex Differences in Neurocognitive Function in Adults with HIV: Patterns, Predictors, and Mechanisms. Curr Psychiatry Rep 2019; 21:94. [PMID: 31522330 PMCID: PMC7673651 DOI: 10.1007/s11920-019-1089-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Sex differences in cognitive function are well documented yet few studies had adequate numbers of women and men living with HIV (WLWH; MLWH) to identify sex differences in neurocognitive impairment (NCI) and the factors contributing to NCI. Here, we review evidence that WLWH may be at greater risk for NCI. RECENT FINDINGS We conducted a systematic review of recent studies of NCI in WLWH versus MLWH. A power analysis showed that few HIV studies have sufficient power to address male/female differences in NCI but studies with adequate power find evidence of greater NCI in WLWH, particularly in the domains of memory, speed of information processing, and motor function. Sex is an important determinant of NCI in HIV, and may relate to male/female differences in cognitive reserve, comorbidities (mental health and substance use disorders), and biological factors (e.g., inflammation, hormonal, genetic).
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Affiliation(s)
- Leah H. Rubin
- Department of Neurology and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Gretchen N. Neigh
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | | | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD,Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eileen P. Scully
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Pauline M. Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL,Department of Psychology, University of Illinois at Chicago, Chicago, IL
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25
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Spies G, Kidd M, Seedat S. A factor analytic study of the Childhood Trauma Questionnaire-Short Form in an all-female South African sample with and without HIV infection. CHILD ABUSE & NEGLECT 2019; 92:157-166. [PMID: 30981158 PMCID: PMC8853848 DOI: 10.1016/j.chiabu.2019.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 02/05/2019] [Accepted: 04/03/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is widely used around the world but no norms have been established for South African users of the CTQ. The CTQ has been employed in South Africa but not yet validated. The present study aims to address this gap. There is great need in both clinical and research settings for an assessment tool that adequately measures childhood trauma, a sensitive and challenging construct to measure. OBJECTIVE This study explores the psychometric properties of the CTQ-SF in an all-female cohort living with and without HIV infection in South Africa, the first study of its kind in this population. PARTICIPANTS AND SETTING The CTQ-SF was administered to 314 women (170 HIV uninfected; 144 HIV infected) in Cape Town, South Africa. METHOD Internal consistency of the CTQ-SF was determined by Cronbach alpha coefficients. Using Lisrel, a confirmatory factor analysis (CFA) was performed, followed by an exploratory factor analysis (EFA) to explore an alternative factor structure model in this cohort. RESULTS For the group as a whole, the model fit was acceptable but not good. However, for the sub-sample of women living with HIV, the CFA revealed poor model fit. The EFA revealed a three-factor model, with mostly stable factor loadings for four of the five subscales. However, the Physical Neglect (PN) subscale cross loaded on two of the three factors. CONCLUSION Our findings revealed an alternative factor structure from the original model in this study cohort. The PN subscale does not have stable factor loadings and is not homogenous. The original instrument may therefore benefit from revision for use in this population. Measures such as the CTQ can be informative for preventative strategies in HIV-infected or at-risk youth and for clinical interventions aimed at mitigating the negative psychological sequelae of childhood maltreatment.
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Affiliation(s)
- Georgina Spies
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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26
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Womersley JS, Spies G, Seedat S, Hemmings SMJ. Childhood trauma interacts with ApoE to influence neurocognitive function in women living with HIV. J Neurovirol 2019; 25:183-193. [PMID: 30478798 PMCID: PMC7010592 DOI: 10.1007/s13365-018-0700-y] [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: 08/13/2018] [Revised: 10/22/2018] [Accepted: 11/09/2018] [Indexed: 12/16/2022]
Abstract
HIV-associated neurocognitive disorder (HAND) describes a spectrum of behavioural, motor and cognitive disturbances that can occur secondary to HIV infection. Less severe forms of the disorder persist despite advances in antiretroviral medication efficacy and availability. Childhood trauma (CT) may predispose individuals to developing HAND. As genetic variation in human apolipoprotein E (ApoE) has been implicated in cognitive decline and may mediate the development of long-term health outcomes following CT, we investigated the influence of ApoE and CT on cognitive function in the context of HIV. One hundred twenty-eight HIV-positive Xhosa women completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF) as well as the HIV Neurobehavioural Research Center neurocognitive test battery. rs7412 and rs429358 were genotyped using KASP assays, and this data was used to determine the ApoE isoform. Baseline differences in demographic and clinical variables according to CT exposure were calculated. Analysis of covariance was used to assess the contributions of CT and ApoE variants, as well as their interaction, to cognitive function. Eighty-eight participants reported experiencing CT. The rs7412 C allele protected against the harmful effect of CT on motor scores using an additive model. The interaction of ApoE ε4 and CT was associated with worse attention/working memory scores. ApoE ε4, alone and in combination with CT, is associated with poorer cognitive function. Further research into this gene-environment interaction may assist in identifying at-risk individuals for targeted interventions.
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Affiliation(s)
- Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Georgina Spies
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
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27
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Rubin LH, Maki PM. Neurocognitive Complications of HIV Infection in Women: Insights from the WIHS Cohort. Curr Top Behav Neurosci 2019; 50:175-191. [PMID: 31396894 DOI: 10.1007/7854_2019_101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Although sex differences in brain function and brain disorders are well documented, very few studies have had adequate number of women to address sex-related factors contributing to HIV-associated brain dysfunction. Compared to men living with HIV (MLWH), women living with HIV (WLWH) may be at greater risk for cognitive dysfunction and decline due to biological factors (e.g., hormonal, immunologic) and issues common in underserved communities including poverty, low literacy levels, mental health and substance abuse, barriers to health-care services, and environmental exposures. To address this issue, we review relevant cross-sectional and longitudinal findings from the Women's Interagency HIV Study (WIHS), the largest study of the natural and treated history of WLWH, as well as other studies focusing on cognitive complications of HIV in women. We provide evidence that WLWH are more cognitively vulnerable than MLWH and that there are differences in the pattern of cognitive impairment. We next discuss factors that contribute to these differences, including biological factors (e.g., inflammation, hormonal, genetic) as well as common comorbidities (mental health, substance use, vascular and metabolic risk factors, coinfections and liver function, non-antiretroviral medications, and genetic markers). These findings demonstrate the importance of considering sex as a biological factor in studies of cognitive dysfunction and suggest avenues for future research.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
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28
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Denckla CA, Spies G, Heaton R, Vasterling J, Franklin D, Korte KJ, Colgan C, Henderson DC, Koenen KC, Seedat S. Generalizability of demographically corrected Zambian neuropsychological norms to South African women. Clin Neuropsychol 2019; 33:40-57. [PMID: 30950749 PMCID: PMC6778499 DOI: 10.1080/13854046.2019.1588995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 01/27/2023]
Abstract
Objective: Demographically corrected norms typically account for the effects of age, education, and in some cases, sex and other factors (e.g. race/ethnicity). However, generalizability of normative standards to different countries and ethnic groups is not universal. This study sought to determine whether demographically specific Zambian neuropsychological norms would generalize to a group of South African women.Method: 212 English-Xhosa bilingual, South African (SA) women were administered a comprehensive neuropsychological (NP) test battery in either English or Xhosa. We examined rates of "impairment" using Global Deficit Scores (GDS) based upon published, demographically corrected norms from a nearby African country (Zambia). Using multiple regression, we examined the extent to which Zambian norms "corrected" for the effects of age and education in this SA sample.Results: Compared to the normative standards from Zambia, the South African women performed somewhat worse than expected on a few test measures and better than expected on others, but their GDS and associated "impairment" rates were close to what was seen in Zambia. Demographically corrected Zambian norms adequately adjusted for the effects of age and years of education in this sample of SA women, with the exception that Zambian norms appeared to "under correct" for the positive effects of years of education on tests of information processing speed.Conclusions: Demographically corrected norms developed for Zambia may adequately adjust for the effects of age in SA women. Further research is needed to determine whether additional corrections for education are needed in SA, especially for tests of information processing speed.
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Affiliation(s)
| | - Georgina Spies
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
| | - Robert Heaton
- HIV Neurobehavioral Research Center at the University of California, La Jolla, CA, USA
| | - Jennifer Vasterling
- VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - Donald Franklin
- HIV Neurobehavioral Research Center at the University of California, La Jolla, CA, USA
| | - Kristina J. Korte
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Courtney Colgan
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Soraya Seedat
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
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29
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Goodman JB, Freeman EE, Chalmers KA. The relationship between early life stress and working memory in adulthood: A systematic review and meta-analysis. Memory 2018; 27:868-880. [DOI: 10.1080/09658211.2018.1561897] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Kanmogne GD, Fonsah JY, Tang B, Doh RF, Kengne AM, Umlauf A, Tagny CT, Nchindap E, Kenmogne L, Franklin D, Njamnshi DM, Mbanya D, Njamnshi AK, Heaton RK. Effects of HIV on executive function and verbal fluency in Cameroon. Sci Rep 2018; 8:17794. [PMID: 30542105 PMCID: PMC6290794 DOI: 10.1038/s41598-018-36193-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/16/2018] [Indexed: 01/02/2023] Open
Abstract
HIV-associated neurocognitive disorders (HAND) are frequently associated with impaired executive function and verbal fluency. Given limited knowledge concerning HAND in Sub-Saharan-Africa and lack of Cameroonian adult neuropsychological (NP) test norms, we administered four executive function [Halstead Category Test (HCT), Wisconsin Card Sorting Test (WCST), Color Trails-II (CTT2), and Stroop Color-Word-Interference (SCWT)] and three verbal fluency (Category, Action, and Letter Fluency) tests to 742 adult Cameroonians (395 HIV-, 347 HIV+). We developed demographically-corrected NP test norms and examined the effects of HIV and related variables on subjects' executive function and verbal fluency. HIV+ subjects had significantly lower T-scores on CTT2 (P = 0.005), HCT (P = 0.032), WCST (P < 0.001); lower executive function composite (P = 0.002) and Action Fluency (P = 0.03) T-scores. ART, viremia, and CD4 counts did not affect T-scores. Compared to cases harboring other viral subtypes, subjects harboring HIV-1 CRF02_AG had marginally higher CTT2 T-scores, significantly higher SCWT (P = 0.015) and executive function (P = 0.018) T-scores. Thus, HIV-1 infection in Cameroon is associated with impaired executive function and some aspects of verbal fluency, and viral genotype influenced executive function. We report the first normative data for assessing executive function and verbal fluency in adult Cameroonians and provide regression-based formulas for computing demographically-adjusted T-scores. These norms will be useful for investigating HIV/AIDS and other diseases affecting cognitive functioning in Cameroon.
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Affiliation(s)
- Georgette D Kanmogne
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Julius Y Fonsah
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Roland F Doh
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Anne M Kengne
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Claude T Tagny
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | | | | | - Donald Franklin
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Dora M Njamnshi
- HIV-Day Care Service, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Dora Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Alfred K Njamnshi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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31
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Spies G, Konkiewitz EC, Seedat S. Incidence and Persistence of Depression Among Women Living with and Without HIV in South Africa: A Longitudinal Study. AIDS Behav 2018; 22:3155-3165. [PMID: 29476437 PMCID: PMC8850942 DOI: 10.1007/s10461-018-2072-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Depression and trauma are common among women living with HIV. This is the first study to track the longitudinal course of depression and examine the relationship between depression and trauma over time among women in South Africa. HIV-infected and uninfected women (N = 148) were assessed at baseline and one year later. Results of a path analysis show the multi-directional and entwined influence of early life stress, other life-threatening traumas across the lifespan, depression and PTSD over the course of HIV. We also observed higher rates of depressive symptomatology and more persistent cases among infected women compared to uninfected women, as well as a more consistent and enduring relationship between childhood trauma and depression among women living with HIV. The present study is unique in documenting the course of untreated depression and PTSD in women with and without HIV infection with a high prevalence of early childhood trauma.
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Affiliation(s)
- Georgina Spies
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | - Elisabete Castelon Konkiewitz
- Faculdade de Ciências Médicas e da Saúde, Universidade Federal da Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Soraya Seedat
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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32
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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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33
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Jacobs S, Moxley K, Womersley JS, Spies G, Hemmings SM, Seedat S. HPA-axis genes as potential risk variants for neurocognitive decline in trauma-exposed, HIV-positive females. Neuropsychiatr Dis Treat 2018; 14:2497-2504. [PMID: 30319260 PMCID: PMC6167976 DOI: 10.2147/ndt.s166992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Previous studies have independently provided evidence for the effects of HIV infection, hypothalamic-pituitary-adrenal (HPA) axis dysfunction and early life trauma on neurocognitive impairment (NCI). This study examined the interaction between single-nucleotide polymorphisms (SNPs) of two HPA axis genes, corticotrophin-releasing hormone receptor 1 (CRHR1; rs110402, rs242924, rs7209436, and rs4792888) and corticotrophin-releasing hormone-binding protein (CRHBP; rs32897, rs10062367, and rs1053989), childhood trauma, and HIV-associated NCI. PATIENTS AND METHODS The sample comprised 128 HIV-positive Xhosa females of whom 88 (69%) had a history of childhood trauma. NCI was assessed using a battery of 17 measures sensitive to the effects of HIV, and the history of childhood trauma was assessed using the validated retrospective Childhood Trauma Questionnaire-Short Form. Generalized linear regression models were used to compare allelic distribution by trauma status and global NCI. The association between genotype, childhood trauma, and cognitive scores was also evaluated using generalized linear regression models, assuming additive models for the SNPs, and ANOVA. RESULTS Of the seven polymorphisms assessed, only the rs10062367 variant of CRHBP was significantly associated with global NCI (P=0.034), independent of childhood trauma. This polymorphism was not significantly associated with z-scores on any specific cognitive domain. The interaction of childhood trauma and variants of CRHR1 was associated with poorer learning (rs110402) and/or recall (rs110402 and rs4792888). CONCLUSION These findings suggest that CRHBP rs10062367 A allele is a possible risk variant for NCI in HIV, independent of childhood trauma. Furthermore, results show that the interaction of childhood trauma with variants of CRHR1, rs110402 and rs4792888, confer added vulnerability to NCI in HIV-infected individuals in cognitive domains that are known to be impacted by HIV. While these findings need independent replication in larger samples, it adds CRHBP and CRHR1 to the list of known genes linked to HIV- and childhood trauma-associated neurocognitive phenotypes.
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Affiliation(s)
- Sean Jacobs
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Karis Moxley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Georgina Spies
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Sian Mj Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
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Womersley JS, Seedat S, Hemmings SMJ. Childhood maltreatment and HIV-associated neurocognitive disorders share similar pathophysiology: a potential sensitisation mechanism? Metab Brain Dis 2017; 32:1717-1733. [PMID: 28681198 DOI: 10.1007/s11011-017-0062-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 01/16/2023]
Abstract
HIV-associated neurocognitive disorders (HAND) are increasingly prevalent despite the use of antiretroviral therapies. Previous research suggests that individual host factors play an important role in determining susceptibility to HAND. In this review, we propose that childhood trauma (CT) and HAND share several common aetiological mechanisms, namely hypothalamic-pituitary-adrenal axis dysregulation, neuroinflammation and oxidative stress. These convergent and consequent mechanisms may translate into an increased risk of developing HAND in individuals who have experienced early life stress. We provide an overview of basic and clinical research relating to these pathophysiological mechanisms and suggest that further research examine brain-derived neurotrophic factor and telomere length as common mediating factors and potential therapeutic targets for HAND and CT. Graphical abstract Both childhood trauma and HIV-associated neurocognitive disorders are associated with HPA axis dysregulation, inflammation and oxidative stress.
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Affiliation(s)
- Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
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Walker KA, Brown GG. HIV-associated executive dysfunction in the era of modern antiretroviral therapy: A systematic review and meta-analysis. J Clin Exp Neuropsychol 2017; 40:357-376. [PMID: 28689493 DOI: 10.1080/13803395.2017.1349879] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE While some reports suggest that HIV+ individuals continue to display executive function (EF) impairment in the era of cART, findings have been contradictory and appear to differ based on the aspect of EF being measured. To improve the understanding of how discrete executive abilities may be differentially affected or spared in the context of HIV infection, we conducted a systematic review and meta-analysis to (a) determine whether and to what extent HIV+ adults experience deficits in EFs, and (b) understand how demographic and clinical characteristics may modify the associations between HIV infection and executive abilities. METHOD Studies comparing HIV+ and HIV-uninfected groups on measures of working memory, set-shifting, inhibition, decision-making, and apathy between 2000 and 2017 were identified from three databases. Effect sizes (Cohen's d) were calculated using inverse variance weighted random effects models. Meta-regression was used to examine the moderating effect of demographic and clinical variables. RESULTS Thirty-seven studies (n = 3935 HIV+; n = 2483 HIV-uninfected) were included in the meta-analysis. Pooled effect sizes for deficits associated with HIV infection were small for domains of set-shifting (d = -0.34, 95% CI [-0.47, -0.20]) and inhibition (d = -0.31, 95% CI [-0.40, -0.21]), somewhat larger for measures of decision-making (d = -0.41, 95% CI [-0.53, -0.28]) and working memory (d = -0.42, 95% CI [-0.59, -0.29]), and largest for apathy (d = -0.87, 95% CI [-1.09, -0.66]). Meta-regression demonstrated that age, sex, education, current CD4 count, and substance dependence differentially moderated the effects of HIV infection on specific EFs. However, lower nadir CD4 count was the only variable associated with greater deficits in nearly all EF domains. CONCLUSIONS Our results suggest that discrete domains of EF may be differentially affected by HIV infection and moderating demographic and clinical variables. These findings have implications for the development of targeted cognitive remediation strategies.
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Affiliation(s)
- Keenan A Walker
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Gregory G Brown
- b Department of Psychiatry , University of California San Diego , San Diego , CA , USA
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Claflin DI, Schmidt KD, Vallandingham ZD, Kraszpulski M, Hennessy MB. Influence of postnatal glucocorticoids on hippocampal-dependent learning varies with elevation patterns and administration methods. Neurobiol Learn Mem 2017; 143:77-87. [PMID: 28545908 DOI: 10.1016/j.nlm.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022]
Abstract
Recent interest in the lasting effects of early-life stress has expanded to include effects on cognitive performance. An increase in circulating glucocorticoids is induced by stress exposure and glucocorticoid effects on the hippocampus likely underlie many of the cognitive consequences. Here we review studies showing that corticosterone administered to young rats at the conclusion of the stress-hyporesponsiveness period affects later performance in hippocampally-mediated trace eyeblink conditioning. The nature and even direction of these effects varies with the elevation patterns (level, duration, temporal fluctuation) achieved by different administration methods. We present new time course data indicating that constant glucocorticoid elevations generally corresponded with hippocampus-mediated learning deficits, whereas acute, cyclical elevations corresponded with improved initial acquisition. Sensitivity was greater for males than for females. Further, changes in hippocampal neurogenesis paralleled some but not all effects. The findings demonstrate that specific patterns of glucocorticoid elevation produced by different drug administration procedures can have markedly different, sex-specific consequences on basic cognitive performance and underlying hippocampal physiology. Implications of these findings for glucocorticoid medications prescribed in childhood are discussed.
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Affiliation(s)
- Dragana I Claflin
- Department of Psychology, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH 45435, USA.
| | - Kevin D Schmidt
- Department of Psychology, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH 45435, USA; Applied Neuroscience Branch, Air Force Research Laboratory, 2510 Fifth St., Wright-Patterson AFB, OH 45433, USA.
| | - Zachary D Vallandingham
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH 45435, USA.
| | - Michal Kraszpulski
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH 45435, USA.
| | - Michael B Hennessy
- Department of Psychology, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH 45435, USA.
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Sassoon SA, Le Berre AP, Fama R, Asok P, Hardcastle C, Chu W, Pfefferbaum A, Sullivan EV. Effects of Childhood Trauma and Alcoholism History on Neuropsychological Performance in Adults with HIV Infection: An Initial Study. JOURNAL OF HIV/AIDS AND INFECTIOUS DISEASES 2017; 4:10.17303/jaid.2017.3.101. [PMID: 38481564 PMCID: PMC10936226 DOI: 10.17303/jaid.2017.3.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Background Childhood trauma carries heightened risk for neuropsychological impairment and is a frequent concomitant of HIV infection (H) and alcoholism (Alc). Little is known about compounded effects of childhood trauma and these diseases on cognitive and motor functioning. We queried the relation between childhood trauma history (experiencing at least 1 of 13 specified traumas before age 18) and cognitive and motor performance in HIV infection with and without lifetime alcoholism. Methods Relations between childhood trauma history (Tr) and four performance domains (episodic memory, information processing speed, executive function, and fine motor function) were examined via ANCOVAs covarying for age and education in four HIV groups: 21 H+Alc+Tr, 19 H+Alc, 19 H+Tr, and 25 HComp (H comparison group without Tr or Alc). Results H+Tr, irrespective of Alc, performed poorly on the episodic memory domain. Specifically, immediate and delayed verbal recall, and immediate visual recall were affected in those with HIV and history of childhood trauma with or without alcoholism history. By contrast, H+Alc+Tr performed faster than H+Alc or H+Tr in information processing speed. Conclusion The findings of poorer episodic memory in HIV infection with childhood trauma history corroborates previous reports and now extends findings to H+Alc+Tr trimorbidity. The novel interaction of alcoholism and trauma in HIV infection suggests that information processing speed is slowed with trauma history or alcoholism history alone in HIV but not with HIV+Alc+Tr trimorbidity, possibly reflecting greater impulsivity and hyperarousal in multiply-affected individuals.
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Affiliation(s)
| | - Anne Pascale Le Berre
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rosemary Fama
- Neuroscience Program, SRI International, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Priya Asok
- Neuroscience Program, SRI International, Menlo Park, CA, USA
| | | | - Weiwei Chu
- Neuroscience Program, SRI International, Menlo Park, CA, USA
| | - Adolf Pfefferbaum
- Neuroscience Program, SRI International, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Denckla CA, Consedine NS, Spies G, Cherner M, Henderson DC, Koenen KC, Seedat S. Associations between neurocognitive functioning and social and occupational resilience among South African women exposed to childhood trauma. Eur J Psychotraumatol 2017; 8:1394146. [PMID: 29163865 PMCID: PMC5687801 DOI: 10.1080/20008198.2017.1394146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/12/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Prior research on adaptation after early trauma among black South African women typically assessed resilience in ways that lacked contextual specificity. In addition, the neurocognitive correlates of social and occupational resilience have not been investigated. Objective: The primary aim of this exploratory study was to identify domains of neurocognitive functioning associated with social and occupational resilience, defined as functioning at a level beyond what would be expected given exposure to childhood trauma. Methods: A sample of black South African women, N = 314, completed a neuropsychological battery, a questionnaire assessing exposure to childhood trauma, and self-report measures of functional status. We generated indices of social and occupational resilience by regressing childhood trauma exposure on social and occupational functioning, saving the residuals as indices of social and occupational functioning beyond what would be expected given exposure to childhood trauma. Results: Women with lower non-verbal memory evidenced greater social and occupational resilience above and beyond the effects attributable to age, education, HIV status, and depressive and posttraumatic stress symptoms. In addition, women with greater occupational resilience exhibited lower semantic language fluency and processing speed. Conclusion: Results are somewhat consistent with prior studies implicating memory effects in impairment following trauma, though our findings suggest that reduced abilities in these domains may be associated with greater resilience. Studies that use prospective designs and objective assessment of functional status are needed to determine whether non-verbal memory, semantic fluency, and processing speed are implicated in the neural circuitry of post-traumatic exposure resilience.
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Affiliation(s)
- C A Denckla
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - N S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - G Spies
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - M Cherner
- HIV Neurobehavioral Research Center, University of California, San Diego, CA, USA
| | - D C Henderson
- Boston Medical Center, Boston University, Boston, MA, USA
| | - K C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - S Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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