Neurocognitive Effects of HIV, Hepatitis C, and Substance Use History

Devlin, Kathryn N.; Gongvatana, Assawin; Clark, Uraina S.; Chasman, Jesse; Westbrook, Michelle L.; Tashima, Karen T.; Navia, Bradford; Cohen, Ronald A.

doi:10.1017/s1355617711001408

Cited by 65 publications

(69 citation statements)

References 112 publications

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“…Detectable HIV-RNA has been associated with reduced executive functioning, verbal fluency, and memory [48]. In our population, only 2 of 13 HAD patient had efficient treatment with undetectable HIV-RNA; the other 11 were untreated or not efficiently treated, and had detectable viral load.…”

Section: Discussionmentioning

confidence: 72%

“…In addition, HIV/HCV coinfection is associated with poorer neurocognitive outcomes than infection with HIV alone [54][55][56]. Devlin et al [48] found significant associations between neurocognitive deficits and HIV load, HCV coinfection and substance abuse. Forton showed elevated frontal white matter myoinositol/creatine in patients with histologically mild liver disease due to HCV infection studied with cerebral proton magnetic resonance spectroscopy [57].…”

Section: Discussionmentioning

confidence: 99%

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Neurological complications of HIV infection in pre-HAART and HAART era: a retrospective study

et al. 2015

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The introduction of highly active anti-retroviral therapy (HAART) led to a radical change in the natural history of HIV infection and of the associated neurological opportunistic infections. However, the mortality of central nervous system (CNS) complications and opportunistic infections is still high in untreated HIV-infected individuals or in patients unaware of their HIV infection. We describe the outcome of HIV-infected patients followed at a single center for AIDS-related neurological syndromes in the 16 years following the introduction of HAART, and compare the findings with those in patients admitted up to 1996. We have conducted a retrospective study of patients with HIV infection or AIDS (based on WHO criteria and classified according to the 1993 CDC criteria) admitted during 20 years (January 1992 to March 2012) to the Infectious Diseases Unit of the University of Verona for the presence of focal or widespread CNS lesion on neuroimaging. Clinical history, CD4 cell count, HIV-RNA level, neurological examination, imaging, cerebrospinal fluid examination and eventual cerebral biopsy results were reviewed as well as the final neurological diagnosis and the treatment. The survival time from the clinical onset of the neurologic syndrome to death was calculated for each patient who died. A statistical analysis was performed comparing data collected up to and after 1996, i.e., before and after HAART introduction. Among 1043 patients with HIV infection or AIDS admitted to the Infectious Diseases Unit of the University of Verona between January 1992 and March 2012, 114 had a CNS lesion. The following diseases were observed: neurotoxoplasmosis (NT), progressive multifocal leukoencephalopathy), primary central nervous system lymphoma (PCNSL), the severe form of HIV-associated neurocognitive disorder, cryptococcal encephalitis (CE) and lesions of undetermined origin. The follow-up period was 4 weeks to 72 months both in the pre-HAART and HAART era. Cerebral lesions were detected in 53/243 patients (21.8%) in the pre-HAART era and in 61/801 patients (7.6%) in the HAART era (p < 0.001). Most patients who developed a neurological complication in the HAART period (40/59, 67.8%) were untreated or did not know to be HIV-infected; in particular, 27.9% of patients with a CNS lesion in the HAART era were unaware of their HIV infection vs 13.2% in the pre-HAART era (p < 0.05). Some patients were not virologically suppressed (14/59, 23.7%) or were immunological non-responders (undetectable viral load, with CD4 count <200 cells/μL; 4/59, 6.8%). Other statistically significant data were the mean age at the onset of neurological complications (32.6 ± 5.4 years in the pre-HAART, 40.3 ± 9.5 in the HAART group, p < 0.001) and the mean CD4 cell count at the onset of illness (median of 38 cells/µL (2-215) in the pre-HAART, 77 cells/µL (2-752) in the HAART group; p < 0.001). In the HAART era a reduction of PCNSL and NT was observed. Our results, while confirming a decrease in the incidence of opportunistic infections of the CNS in the ...

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Neurological complications of HIV infection in pre-HAART and HAART era: a retrospective study

et al. 2015

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“…Finally, we examined the associations between occupational and social resilience and neurocognitive functioning metrics found to be significant in the previous step by entering age, education, HIV status, depressive symptoms, and PTSD symptoms in step one of a hierarchical regression model given the known effect of these variables on neurocognitive performance (Devlin et al, 2012; McClintock et al, 2010; Scott et al, 2015), and then entering the neuropsychological variable in the second step. Regression coefficients for the second step of each model, as well as the R 2 change, are reported in Table 3.…”

Section: Resultsmentioning

confidence: 99%

“…Next, we proceeded with a focused analysis of the significant associations evident in the univariate correlations by conducting a series of hierarchical multivariate regressions. As age, education, and HIV status are known to predict neurocognitive performance (Devlin et al, 2012), as well as depressive symptoms (McClintock, Husain, Greer, & Cullum, 2010) and Posttraumatic Stress Disorder (PTSD; American Psychiatric Association, 2000; Scott et al, 2015), these variables were entered in the first step to capture within-source variability. Then, neuropsychological variables were entered in the second step to measure between-source variability, thereby isolating the variance explained by our neuropsychological variables.…”

Section: Analytic Strategymentioning

confidence: 99%

Associations between neurocognitive functioning and social and occupational resilience among South African women exposed to childhood trauma

Denckla

Consedine

Spies

et al. 2017

European Journal of Psychotraumatology

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Background: Prior research on adaptation after early trauma among black South African women typically assessed resilience in ways that lacked contextual specificity. In addition, the neurocognitive correlates of social and occupational resilience have not been investigated. Objective: The primary aim of this exploratory study was to identify domains of neurocognitive functioning associated with social and occupational resilience, defined as functioning at a level beyond what would be expected given exposure to childhood trauma. Methods: A sample of black South African women, N = 314, completed a neuropsychological battery, a questionnaire assessing exposure to childhood trauma, and self-report measures of functional status. We generated indices of social and occupational resilience by regressing childhood trauma exposure on social and occupational functioning, saving the residuals as indices of social and occupational functioning beyond what would be expected given exposure to childhood trauma. Results: Women with lower non-verbal memory evidenced greater social and occupational resilience above and beyond the effects attributable to age, education, HIV status, and depressive and posttraumatic stress symptoms. In addition, women with greater occupational resilience exhibited lower semantic language fluency and processing speed. Conclusion: Results are somewhat consistent with prior studies implicating memory effects in impairment following trauma, though our findings suggest that reduced abilities in these domains may be associated with greater resilience. Studies that use prospective designs and objective assessment of functional status are needed to determine whether non-verbal memory, semantic fluency, and processing speed are implicated in the neural circuitry of post-traumatic exposure resilience.

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“…Overall, most studies reported that the HIV/HCV co-infected patients were generally more impaired than HIV and HCV monoinfected patients and controls Ciccarelli et al, 2013;Clifford, Evans, Yang, & Gulick, 2005;Devlin et al, 2012;von Giesen et al, 2004;Hinkin et al, 2008;Letendre et al, 2005;Martin et al, 2004;Parsons et al, 2006;Rempel et al, 2013;Ryan, Morgello, Isaacs, Naseer, & Gerits, 2004;Sun et al, 2013;Vivithanaporn et al, 2012). Other studies found no differences on cognitive performance between HIV/ HCV and HIV mono-infected groups (Aronow, Weston, Pezeshki, & Lazarus, 2008;Thiyagarajan et al, 2010), between HIV/HCV and HCV mono-infected groups (Clifford et al, 2009;Perry et al, 2005), and between HIV/HCV and both HIV and HCV mono-infected groups (Thein et al, 2007).…”

Section: Cognitive Impairmentmentioning

confidence: 98%

Cognitive impairment in HIV and HCV co-infected patients: a systematic review and meta-analysis

et al. 2016

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Cognitive impairment has been well documented in human immunodeficiency virus (HIV) and hepatitis C virus (HCV) mono-infections. However, in the context of HIV/HCV co-infection the research is more limited. The aim of this systematic review was to describe the characteristics of cognitive impairment in HIV/HCV co-infection and to examine the differences in cognitive performance between HIV/HCV and HIV and HCV mono-infected patients. Of the 437 records initially screened, 24 papers met the inclusion criteria and were included in the systematic review. Four studies were included in the meta-analysis. Most studies indicated that HIV/HCV co-infected patients had a higher level of cognitive impairment than HIV mono-infected patients. Meta-analysis also indicated that HIV mono-infected patients had a significantly lower global deficit score than co-infected patients. The results also indicated that co-infected patients were more likely to be impaired in information processing speed than HIV mono-infected patients. These findings can be challenged by biasing factors such as the small number of included studies, heterogeneity of the samples and a large diversity of methodological procedures. Future research with consistent and comprehensive neuropsychological batteries and covering a greater diversity of risk factors is needed, in order to clarify the effects of both viruses on cognitive function and the mechanisms that underlie these effects. Because cognitive impairments may pose significant challenges to medication adherence, quality of life and overall functioning, such knowledge may have important implications to the planning and implementation of effective interventions aimed at optimising the clinical management of these infections. ARTICLE HISTORY

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Neurocognitive Effects of HIV, Hepatitis C, and Substance Use History

Cited by 65 publications

References 112 publications

Neurological complications of HIV infection in pre-HAART and HAART era: a retrospective study

Neurological complications of HIV infection in pre-HAART and HAART era: a retrospective study

Associations between neurocognitive functioning and social and occupational resilience among South African women exposed to childhood trauma

Cognitive impairment in HIV and HCV co-infected patients: a systematic review and meta-analysis

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