Evidence for neuropsychological health disparities in Black Americans with HIV disease

Abstract

Black Americans are at high risk for HIV disease and associated morbidity. However, we know little about the neuropsychological impact and correlates of HIV disease among Black Americans. Methods: Participants included 40 Black persons with HIV (PWH), 83 White PWH, 28 Black HIV-and 64 White HIV-individuals. Neurocognition was measured with raw, sample-based zscores from a clinical battery. Everyday functioning was assessed using self-and clinician-rated measures of cognitive symptoms and activities of daily living. HIV-associated neurocognitive disorders were classified using the Frascati criteria. Results: We observed a significant three-way interaction between HIV, race, and domain on neurocognitive z-scores. This omnibus effect was driven by large effect size decrements in semantic memory and processing speed in Black PWH compared to the other groups.Black PWH participants also demonstrated higher frequencies of HIV-associated neurocognitive disorders as compared to White PWH. Unexpectedly, global neurocognition was negatively related to everyday functioning for White PWH, but not for Black PWH. Conclusions: Systemic disadvantages for Black Americans may combine with HIV disease to compound some neurocognitive impairments in this vulnerable population. Prospective studies are needed to identify better ways to prevent and manage HIVassociated neurocognitive disorders among Black Americans.

HIV Antiretroviral Medication Neuropenetrance and Neurocognitive Outcomes in HIV+ Adults: A Review of the Literature Examining the Central Nervous System Penetration Effectiveness Score

“…No study to date has explored whether or not CPE scores differ across racial/ethnic groups and factors that may drive any potential discrepancies. This is especially pertinent in the USA, where there are well-documented health disparities and systemic disadvantages among minoritized racial/ethnic groups in HIV [68,69]. Particularly, individuals who identify as Black/African American and/or Hispanic/Latinx, minoritized groups are not only disproportionately affected by HIV disease, but also receive poorer quality HIV-related healthcare, including delayed treatment [70,71] and less access to HIV medications, particularly newer medications [72,73].…”