Mortality risks in gay men with human immunodeficiency virus infection and cognitive impairment

Mayeux, Richard; Stern, Yaakov; Tang, Ming X.; Todak, George; Marder, Karen; Sano, Mary; Richards, Marcus; Stein, Zena; Ehrhardt, Anke Α.; Gorman, J.M.

doi:10.1212/wnl.43.1_part_1.176

Cited by 88 publications

(43 citation statements)

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“…In the U.S., research prior to aviability of Highly Active Antiretroviral Treatment (HAART) demonstrated that presence of neuropsychological (NP) impairment in HIV infected persons conferred an increased risk early mortality, above and beyond what could be predicted from medical indices of disease progression (Mayeux et al, 1993;Ellis et al, 1997). It is unclear whether NP impairment still produces worse medical outcomes in the context of HAART, but there is considerable evidence that even mild NP impairment is associated with reduced vocational functioning and other difficulties with cognitive aspects of everyday functioning: medication management, driving, and Instrumental Activities of Daily Living (IADLs; Carter et al, 2003;Heaton et al, 2004a;Hinkin et al, 2004;Marcotte et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China

et al. 2008

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The HIV epidemic in China has expanded rapidly in recent years, but little is known about the prevalence and features of HIV Associated Neurocognitive Disorders (HANDs) in this part of the world. We administered a comprehensive Western neuropsychological (NP) test battery to 203 HIV+ and 198 HIV-former plasma donors in the rural area of Anhui province. We found that 26% in the HIV-sample, and 46% in the HIV+ sample were infected with HCV, which can also have CNS effects. To classify NP impairment, we developed demographically corrected test norms based upon individuals free of both infections (N=141). Using a global summary score, NP impairment was found in 34.2% of the HIV mono-infected group and 39.7% of the co-infected group, as compared to 12.7% of the uninfected controls (p<.001). HIV+ participants with AIDS were more likely to be impaired (43%) than non-AIDS individuals (29%, p<.05). Lastly, when all infection groups were combined, participants with NP impairment reported more cognitive complaints (p<.01) and increased dependence in everyday functioning (p=.01). In sum, NP impairment in this large rural Chinese sample was associated with both HIV and HCV infections, and the impairment's prevalence, severity, and pattern were similar to those reported by Western studies. Clinical significance of NP impairment in this population is suggested by the participants' reports of reduced everyday functioning. These findings indicate that HAND is likely to be an important feature of HIV infection in developing countries, underscoring the need for international efforts to develop CNS relevant treatments.

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Section: Introductionmentioning

confidence: 99%

Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China

et al. 2008

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“…Future longitudinal research should determine whether patterns of neuropsychological performance are stable and whether they predict differences in neuropsychological change (e.g., worsening) over time and other clinically relevant outcomes, either independently or in concert with level of performance indicators (e.g., the Global Deficit Score). Outcomes of interest include unemployment (Benedict, Mezhir, Walsh, & Hewitt, 2000;Heaton et al, 2004a;Rabkin, McElhiney, Ferrando, Van Gorp, & Lin, 2004), difficulties on performance-based instrumental activities of daily living (Benedict et al, 2000;Heaton et al, 2004a), adherence to prescribed medication regimens (Hinkin et al, 2002;Levine et al, 2005), complaints of cognitive problems in everyday functioning (Heaton et al, 2004a), and early mortality Mayeux et al, 1993). Also of interest is whether the neuropsychological profiles identified here, especially when seen with HIV-infected people who also have impaired overall levels of neuropsychological functioning, will be associated with differential patterns of brain abnormalities on neuroimaging (Ragin et al, 2005;Tucker et al, 2004) and postmortem neuropathology studies (Cherner et al, 2002b;Ellis et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Variable patterns of neuropsychological performance in HIV-1 infection

Dawes

Suárez

Casey

et al. 2008

Journal of Clinical and Experimental Neuropsychology

106

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Based upon prior findings with group means, a "prototypical pattern" of neuropsychological results with HIV infection has emerged: impaired executive functioning, motor skills, speed of information processing, and learning, with intact memory retention, most language skills, and visuospatial functioning. We examined neuropsychological results from 553 HIV+ adults to determine the number of patterns seen among individuals with HIV infection. Factor analysis of a relatively comprehensive neuropsychological battery identified 6 component factors: verbal memory (VeM), visual memory (ViM), processing speed (PS), attention/working memory (A/ WM), executive function (EF), and motor (M). These factor scores were submitted to hierarchical cluster analysis, to determine the appropriate number of clusters or patterns in the cohort. Final cluster membership was then determined by K-means analysis, based on the Lange, Iverson, Senior, and Chelune (2002) method. A 6-cluster solution was found to be most appropriate. The definitions of the clusters were based upon ipsative scoring of factor scores to indicate relative strengths and weaknesses (independent of overall level of performance): Cluster 1: strong EF; Cluster 2: strong M, weak VeM and EF; Cluster 3: strong PS, weak ViM and EF; Cluster 4: strong VeM, weak M; Cluster 5: strong A/WM; Cluster 6: strong VeM, weak EF. Neuropsychologicalimpairment rates differed across clusters, but all 6 clusters contained substantial numbers of impaired and unimpaired individuals. Cluster membership was not explained by demographic variables or psychiatric or neuromedical confounds. Thus, there does not appear to be a single, prototypical pattern of neuropsychological impairment associated with HIV infection for this battery of representative neuropsychological tests.In using neuropsychological tests for diagnostic purposes, clinicians typically evaluate a range of abilities and then compare the pattern of results with expectations for various types of brain disorders. Although these decisions are made for individual patients, most of the research concerning patterns of impairment considered prototypical of disorders involves analysis of group averages rather than examination of individual performance. This invites the possibly unwarranted assumption that patterns of group means on tests apply to most or all of the individuals within the groups.For example, in general, studies of individuals infected with HIV suggest a prototypical pattern involving poor attention and working memory, speed of information processing, learning, executive functions, and motor skills, but with relatively intact language skills, visuospatial skills, memory (delayed retention), and sensory-perceptual skills (Heaton et al., 1995;Reger, Welsh, Razani, Martin, & Boone, 2002;Sahakian et al., 1995). This pattern is consistent with neuropathological and neuroimaging evidence of preferential involvement of fronto-striatal brain areas in individuals infected with HIV (Pomara, Crandall, Choi, Johnson, & Lim, 2001...

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“…Within the context of HIV infection, results of NP testing have shown robust associations with structural and functional brain imaging (Jernigan et al, 1993;Stout et al, 1998), as well as with postmortem neuropathology findings (Cherner et al, 2002;Everall et al, 1999;Masliah et al, 1997;Moore et al, 2006). Moreover, NP impairment in HIV-infected persons has been shown to be an independent predictor of early mortality Mayeux et al, 1993) and to be strongly predictive of a wide variety of difficulties in activities of daily living (Heaton et al, 2004a).…”

Section: Introductionmentioning

confidence: 99%

Neurobehavioral effects of HIV-1 infection in China and the United States: A pilot study

Cysique

Jin

Franklin

et al. 2007

J. Inter. Neuropsych. Soc.

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The HIV epidemic in China has been increasing exponentially, yet there have been no studies of the neurobehavioral effects of HIV infection in that country. Most neuroAIDS research has been conducted in Western countries using Western neuropsychological (NP) methods, and it is unclear whether these testing methods are appropriate for use in China. Twenty-eight HIV seropositive (HIV+) and twenty-three HIV seronegative (HIV−) individuals with comparable gender, age, and education distributions were recruited in Beijing and the rural Anhui province in China. Thirtynine HIV+ and thirty-one HIV− individuals were selected from a larger U.S. cohort recruited at the HIV Neurobehavioral Research Center, in San Diego, to be matched to the Chinese sample for age, disease status, and treatment variables. The NP test battery used with the U.S. and China cohorts included instruments widely used to study HIV infection in the United States. It consisted of 14 individual test measures, each assigned to one of seven ability areas thought to be especially vulnerable to effects of HIV on the brain (i.e., verbal fluency, abstraction/executive function, speed of information processing, working memory, learning, delayed recall, and motor function). To explore the cross-cultural equivalence and validity of the NP measures, we compared our Chinese and U.S. samples on the individual tests, as well as mean scaled scores for the total battery and seven ability domains. On each NP test measure, the mean of the Chinese HIV+ group was worse than that of the HIV−group. A series of 2 × 2 analyses of variance involving HIV+ and HIV− groups from both countries revealed highly significant HIV effects on the Global and all Domain mean scaled scores. Country effects appeared on two of the individual ability areas, at least partly due to education differences between the two countries. Importantly, the absence of HIV-by-Country interactions suggests that the NP effects of HIV are similar in the two countries. The NP test battery that was chosen and adapted for use in this study of HIV in China appears to have good cross-cultural equivalence, but appropriate Chinese norms will be needed to identify disease-related impairment in individual Chinese people. To inform the development of such norms, a much larger study of demographic effects will be needed, especially considering the wide range of education in that country.

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Mortality risks in gay men with human immunodeficiency virus infection and cognitive impairment

Cited by 88 publications

References 0 publications

Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China

Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China

Variable patterns of neuropsychological performance in HIV-1 infection

Neurobehavioral effects of HIV-1 infection in China and the United States: A pilot study

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