A composite of multisystem injury and neurocognitive impairment in HIV infection: association with everyday functioning

Abstract

The Veterans Aging Cohort Study (VACS) Index is a composite marker of multisystem injury among HIV-infected persons. We aimed to examine its cross-sectional association with functional outcomes, after considering neurocognitive impairment (NCI) and other well-established correlates of everyday functioning among HIV-infected persons. Participants included 670 HIV-infected adults (ages 18-76; 88% male; 63% non-Hispanic White; median current CD4 = 404 cells/mm; 67% on antiretroviral therapy; AIDS = 63%) enrolled in observational studies at the University of California San Diego HIV Neurobehavioral Research Program. Functional outcomes were assessed via self-report measures of declines in activities of daily living, perceived cognitive symptoms in daily life, and employment status. NCI was assessed via a comprehensive neurocognitive test battery and defined based on established methods. Covariates examined included demographics, HIV disease characteristics not included in the VACS Index, and psychiatric comorbidities. The VACS Index was computed via standard methods and categorized based on its distribution. Results from multivariable regression models showed that both higher VACS Index scores (indicative of worse health) and the presence of NCI were independently associated with declines in activities of daily living, increased cognitive symptoms in daily life, and unemployment. These independent effects remained after adjusting for significant covariates. In conclusion, the VACS Index may be a useful tool for identifying HIV-infected patients at high risk for everyday functioning problems. Considering factors such as NCI, historical HIV disease characteristics, and current mood might be particularly important to enhance the predictive power of the VACS Index for functional status among HIV-infected persons.

HIV, Depression, and Cognitive Impairment in the Era of Effective Antiretroviral Therapy

“…The most serious complication of depression in PLWH is the two-fold increased risk of mortality [11], but cognitive impairment (CI) is also an important complication, one that is associated with decreased daily function [12][13][14][15][16][17][18][19][20] and quality of life [21][22][23][24]. Meta-analyses indicates that depression is associated with ARV non-adherence (r=0.…”

Impact of HIV-Associated Cognitive Impairment/Functioning On Functional Independence, Frailty And Quality of Life In The Modern Era: A Systematic Review With Meta-Analysis

“…Still, there was no publication bias (Eggers intercept=7.3727, p=0.3340). Only two studies examined the impact of cognitive function on employment, with effect sizes (r=0.33) (36) and (r= -0.26) [20].…”

“…Existing literature presents con icting evidence. While some studies report that HAND has a strong in uence on medication adherence [15], ADL (16), and QOL [17], other studies have reported weak or no association between HAND and medication adherence [18], ADL [19,20], frailty [21], and QOL [22]. Two systematic reviews [3,23], have tried to synthesize existing evidence but did not conduct a meta-analysis of ndings.…”

Association between Veterans Aging Cohort Study (VACS) index and neurocognitive function among people living with HIV–a cross sectional study in coastal South India

“…The clinical features of NCI include memory impairment, cognitive slowing, decreased fine motor functions and processing speed, all of which cause a significant drop in the capability to perform Activities of Daily Living (ADL). This in turn leads to an overall poor Quality of Life [ 11 ].…”