Measuring and managing cognitive impairment in HIV

Nightingale, Sam; Winston, Alan

doi:10.1097/qad.0000000000001402

Cited by 15 publications

(8 citation statements)

References 65 publications

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“…This could be because the majority of participants in this study were on an efavirenz (EFV) based regimen. Previous studies have shown increased NCI in people on an EFV based regimen [14,48,49]. This is the first line treatment given to adults living with HIV in Zimbabwe.…”

Section: Discussionmentioning

confidence: 99%

Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe

et al. 2020

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Background: HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. It typically affects memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning cognitive domains. NCI can affect adherence to antiretroviral therapy (ART), employability, driving ability and activities of daily living. NCI is not routinely screened for in Zimbabwe, and the burden is not known in this setting. The objectives of this study were: 1) To determine NCI prevalence using a comprehensive neuropsychological battery at two primary health care clinics in Harare; 2) To assess the pattern of cognitive impairment across cognitive domains using a gold standard neuropsychological (NP) battery in HIV-positive patients compared to HIV-negative controls. Methods: Inclusion criteria: 18 years or older; minimum 7 years education; no neurological or psychiatric disorders. HIV-positive participants were on ART for ≥3 months; HIV-negative participants had a confirmed HIV negative status in the past month. A comprehensive NP battery, functional assessments, demographic and medical history questionnaires were administered. The NP battery consisted of tests assessing memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning. Results: Two-hundred-and-thirty-one participants were recruited. Of those, 155 were HIV-positive (Female = 70%, Age M = 37.8; SD 11.2) and 76 HIV-negative (Female = 63%, Age M = 31.2; SD 9.9). HIV-positive participants were on ART for an average of 6 years. NCI was present in 49.7% HIV positive participants. Compared to HIV-negative participants, the HIV-positive group had significantly poorer scores in 5 out of 7 cognitive domains. A good level of education is negatively correlated with NCI. Conclusions: NCI prevalence in HIV-positive population Zimbabwe is consistent with global estimates. NCI persists in adults who are on ART. Routine assessment of NCI in adults attending primary care clinics using this adapted battery is therefore important so that they are identified early and are provided the necessary interventions.

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Section: Discussionmentioning

confidence: 99%

Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe

et al. 2020

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“…Many diagnostic proposals have been suggested for use during the diagnosis of HAND [14,15], although the Frascati criteria [16] are the most universally used nosology and are considered the gold standard in HIV research. This scheme identifies three HAND severity levels: asymptomatic neurocognitive impairments (ANIs), mild neurocognitive disorders (MND), and HIVassociated dementia (HAD) [17].…”

Section: Classification and Diagnosis Of Hiv-associated Neurocognitive Disorder Phenotypesmentioning

confidence: 99%

Important role of microglia in HIV-1 associated neurocognitive disorders and the molecular pathways implicated in its pathogenesis

et al. 2020

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The development of effective combined anti-retroviral therapy (cART) led to a significant reduction in the death rate associated with human immunodeficiency virus type 1 (HIV-1) infection. However, recent studies indicate that considerably more than 50% of all HIV-1 infected patients develop HIV-1-associated neurocognitive disorder (HAND). Microglia are the foremost cells infected by HIV-1 in the central nervous system (CNS), and so, are also likely to contribute to the neurotoxicity observed in HAND. The activation of microglia induces the release of pro-inflammatory markers and altered secretion of cytokines, chemokines, secondary messengers, and reactive oxygen species (ROS) which activate signalling pathways that initiate neuroinflammation. In turn, ROS and inflammation also play critical roles in HAND. However, more efforts are required to understand the physiology of microglia and the processes involved in their activation in order to better understand the how HIV-1-infected microglia are involved in the development of HAND. In this review, we summarize the current state of knowledge about the involvement of oxidative stress mechanisms and role of HIV-induced ROS in the development of HAND. We also examine the academic literature regarding crucial HIV-1 pathogenicity factors implicated in neurotoxicity and inflammation in order to identify molecular pathways that could serve as potential therapeutic targets for treatment of this disease. KEY MESSAGES Neuroinflammation and excitotoxicity mechanisms are crucial in the pathogenesis of HAND. CNS infiltration by HIV-1 and immune cells through the blood brain barrier is a key process involved in the pathogenicity of HAND. Factors including calcium dysregulation and autophagy are the main challenges involved in HAND.

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“…Several factors may contribute to cognitive impairment, including viral factors, neuroinflammation, antiretroviral factors, mental health conditions, comorbid conditions, lifestyle factors, and aging [ 16 , 17 ]. HIV infects the nervous system [ 18 ], and the central nervous system acts as a sanctuary for HIV despite the effectiveness of ART [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…The risks of NCI increase with age and may be more notable in PLWH. Moreover, the interaction between aging and the impaired immune response caused by HIV leads to a premature and persistent inflammatory state that could accelerate cognitive changes [ 16 , 20 , 21 ]. The process of cognitive impairment is reflected by biomarkers, such as CD4 cell count [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral therapy improves neurocognitive impairment in people living with HIV? A meta-analysis

Gao

Meng

Xiao

et al. 2020

International Journal of Nursing Sciences

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Objectives Although effective antiretroviral therapy (ART) has been used for more than two decades, HIV-associated neurocognitive disorder remains prevalent. Thus, whether ART can improve neurocognitive impairment is controversial. This review aims to explore the effects of ART on cognitive impairment in people living with HIV (PLWH). Methods A systematic literature search was conducted in eight databases (PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, China Biology Medicine disc, and WanFang) to identify studies that compare cognitive function between study groups who are administered and not administered ART. We searched for articles published up to April 2019. Article evaluation and data extraction were independently conducted by two reviewers. Results Sixteen articles (6,694 participants)—14 cross-sectional studies and 2 cohort studies—were included in this meta-analysis. The cross-sectional studies demonstrated that ART group did not perform better than the non-ART group ( OR = 1.16; 95% CI, 1.03–1.30). However, the cohort studies reported a significant improvement in cognitive function at three months ( OR = 4.01; 95% CI , 2.35–6.85) and six months ( OR = 9.24; 95% CI, 1.71–49.96) after ART initiation compared with the baseline data. No significant cognitive improvement was found in participants younger than 55 years old, but the two cross-sectional studies showed that ART may improve cognitive function in PLWH under 65 years old with poor physical condition and immune status. Conclusions ART could improve cognitive function in PLWH with poor physical condition and immune status, but it does not considerably improve cognition in the entire PLWH population.

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Measuring and managing cognitive impairment in HIV

Cited by 15 publications

References 65 publications

Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe

Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe

Important role of microglia in HIV-1 associated neurocognitive disorders and the molecular pathways implicated in its pathogenesis

Antiretroviral therapy improves neurocognitive impairment in people living with HIV? A meta-analysis

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