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

Abstract

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.

HIV, Antiretroviral Therapies, and the Brain

“…In addition, HIV-monoinfected and HIV-co-infected subjects experienced reduced employment or work time in the span of a year. These results build on previous studies conducted in China by Cysique et al [51], which demonstrated significant NP deficits in HIV-positive individuals in comparison with HIV-negative controls.…”

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

“…Details of the NP battery selection and adaptation for use in China are provided in Cysique et al (2007a). The NP battery in Mandarin was administered by trained examiners in the local Fuyang dialect, which uses the same written form as the Mandarin, but sometimes is pronounced differently.…”

“…However, there is preliminary evidence of NP and electroencephalographic abnormalities being associated with clade C infection in India (Riedel et al, 2006;Sinha & Satishchandra, 2003;Yepthomi et al, 2006). Finally, Cysique et al (2007a) recently reported a small study comparing NP effects of HIV infection (clade B) in China and the U.S. An NP test battery that has been used in large multi-site studies in the U.S. was translated and adapted slightly for cultural relevance to the Chinese population, and was administered to 28 HIV+ and 23 demographically similar HIV − controls in China, as well as to 39 HIV+ and 31 HIV− controls in the U.S.. The test battery was well understood and tolerated by the Chinese participants.…”

Neurocognitive disturbances in HIV

“…When tests are translated and modified in a culturally and linguistically relevant manner, then the results of neuropsychological assessment of HIV infected persons in non-western settings are beginning to yield similar results to those from North America and Europe. For example, recent preliminary work by Heaton and colleagues (Cysique et al, 2007) shows that norms originally developed in the US could be applied to suitably modified versions of neuropsychological tests in China to demonstrate very similar rates of NP impairment in HIVþ individuals to what has been observed in the United States. Preliminary data involving translations into Marathi (an Indian Other factors that may need to be considered in evaluating the neurocognitive effects of HIV People with HIV infection may have other attributes and conditions that could either exert additive effects on HIV related brain disease, or may make it difficult to disentangle HIV effects from the effects of various confounds.…”