Effects of trauma, economic hardship, and stress on neurocognition and everyday function in HIV.

Abstract

Objective: The causes of neurocognitive and everyday functioning impairment among aging people living with HIV (PLWH) are multifactorial. Exposure to stress and trauma can result in neurocognitive deficits via activation of neurological and other biological mechanisms. Methods: PLWH (n=122) and persons without HIV (n=95), 35–65 years of age, completed four questionnaires that were used to generate a trauma, economic hardship (food insecurity and low socioeconomic status), and stress composite variable (TES). Participants also completed a comprehensive neuropsychological battery and standardized self-reports of activities of daily living (ADLs). We examined the independent and interactive effects of TES and HIV status on neurocognitive performance and ADL declines. Results: PLWH had more traumatic events, more food insecurity, lower socioeconomic status, and higher perceived stress compared to HIV- individuals (all ps<.0001). Among PLWH, a higher composite TES score was associated with worse executive functioning (p=.02), worse learning (p=.02), worse working memory (p=.02), and more ADL declines (p<.0001), even after controlling for relevant demographic, psychiatric, substance use, and HIV disease covariates. On their own, individual TES components did not predict these outcomes. Conversely, no significant relationships were observed between TES and cognitive domains nor ADL declines among HIV- individuals. Conclusions: A composite score of trauma, economic hardship, and stress was significantly associated with worse neurocognitive performance and functional declines among PLWH. These adverse experiences may contribute to neurocognitive and daily functioning difficulties commonly observed among PLWH. Longitudinal studies are needed to elucidate the relationships between economic/psychosocial adversity and cognitive/functional outcomes over time, and examine potential mediators, such as inflammatory biomarkers.

Brain Reward Function after Chronic and Binge Methamphetamine Regimens in Mice Expressing the HIV-1 TAT Protein

“…There is evidence supporting an interaction between stress and HIV on brain function. For example, in people with HIV, greater impairments in cognitive function have been associated with increased stress, and increased stress was associated with greater declines in activities of daily living in HIV+ individuals but not in those without HIV [36]. Interestingly, we did observe a differential effect of chronic and binge methamphetamine regimens on reward thresholds in TAT+ mice during doxycycline administration.…”

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 ).…”

“…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.…”

“…Regarding verbal fluency, five studies demonstrated an association with PTEs and SLEs (Malan-Muller Pukay-Martin et al, 2003;Rubin et al, 2017;Spies et al, 2016Spies et al, , 2017Watson et al, 2019). For attention/working memory, seven studies demonstrated an association with trauma (Clark et al, 2018;Kapetanovic et al, 2020;Lin et al, 2011;Pukay-Martin et al, 2003;Spies et al, 2016;Watson et al, 2019;Womersley et al, 2019); four studies demonstrated an association with processing speed, (Clark et al, 2012;Pukay-Martin et al, 2003;Spies et al, 2016; six studies demonstrated an association with learning (Rubin et al, 2017(Rubin et al, , 2015Spies et al, 2016Watson et al, 2019) while three studies demonstrated an association with motor function (Pukay-Martin et al, 2003;Spies et al, 2016;Womersley et al, 2019). Two studies (Deiss et al, 2019;Pukay-Martin et al, 2003) reported an association between global NCI and trauma (i.e.…”