Effect of HIV and Interpersonal Trauma on Cortical Thickness, Cognition, and Daily Functioning

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 χ2 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.

The relationship between potentially traumatic or stressful events, HIV infection and neurocognitive impairment (NCI): a systematic review of observational epidemiological studies

“…The average age for fourteen of fifteen studies, (one study reported the age range only) was 40 years. Eight were all-female studies (Malan-Muller et al, 2013 ; Rubin et al, 2017 , 2015 , 2016 ; Spies et al, 2016 , 2012 ; Spies, Fennema-Notestine, Cherner, & Seedat, 2017 ; Womersley, Spies, Seedat, & Hemmings, 2019 ) and two were all-male studies (Deiss et al, 2019 ; Pukay-Martin, Cristiani, Saveanu, & Bornstein, 2003 ), with the remainder (five studies) including both men and women (Clark, Arce Renteria, Hegde, & Morgello, 2018 ; Clark et al, 2012 ; Kapetanovic et al, 2020 ; Lin et al, 2011 ; Watson et al, 2019 ).…”

“…There were ten case-control studies (Clark et al, 2012 ; Kapetanovic et al, 2020 ; Malan-Muller et al, 2013 ; Pukay-Martin et al, 2003 ; Rubin et al, 2017 , 2015 ; Spies et al, 2016 , 2012 , 2017 ; Watson et al, 2019 ) and five cross-sectional studies (Clark et al, 2018 ; Deiss et al, 2019 ; Lin et al, 2011 ; Rubin et al, 2016 ; Womersley et al, 2019 ). Eight studies were longitudinal in design (Malan-Muller et al, 2013 ; Rubin et al, 2017 , 2015 , 2016 ; Spies et al, 2016 , 2012 , 2017 ; Womersley et al, 2019 ) but only one of these presented longitudinal data examining the relationship between childhood trauma and HIV and change in cognition over time (Spies et al, 2017 ) and one examined the relationship between perceived stress and PTSD and NCI over time (Rubin et al, 2017 ).…”

“…The majority of studies ( n = 12) measured trauma using self-report questionnaires, with the exception of one study which included self-reported medical histories of Traumatic Brain Injury (TBI) to examine if PLWHA with a clear history of TBI had greater risk of NCI compared to those without TBI (Lin et al, 2011 ), one study which included the Composite International Diagnostic Interview (CIDI) to assess for a DSM-IV diagnosis of PTSD and other mental health conditions (Deiss et al, 2019 ), and another study which included the Client Diagnostic Questionnaire (CDQ) to assess for interpersonal trauma (IPT history) and PTSD. Overall, current or past PTSD was assessed for in four studies (Deiss et al, 2019 ; Kapetanovic et al, 2020 ; Rubin et al, 2017 , 2016 ).…”

“…Of the fifteen studies, seven studies (Clark et al, 2018 , 2012 ; Malan-Muller et al, 2013 ; Spies et al, 2016 , 2012 , 2017 ; Womersley et al, 2019 ) examined early life trauma only (experienced before the age of 18) and seven studies (Deiss et al, 2019 ; Lin et al, 2011 ; Pukay-Martin et al, 2003 ; Rubin et al, 2017 , 2015 , 2016 ; Watson et al, 2019 ) examined adult-onset trauma only (experienced after age 18). Only one study considered both early life and adult-onset trauma (Kapetanovic et al, 2020 ) but no studies sought to separate out the effects of early-onset versus adult-onset trauma. One study from the USA assessed the combined effects of PTEs (through a perceived stress measure) and PTSD (PTEs + PTSD) on NCI (Rubin et al, 2017 ).…”

“…In summary, reporting of data is adequate. Low Kapetanovic et al, 2020 187 individuals (102 with HIV and IPT; 35 with HIV only; 24 HIV-negative with IPT; 26 HIV-negative). Source of the cohort is clear.…”