Neuropsychological Changes in a Prospectively Followed Cohort of Homosexual and Bisexual Men With and Without HIV Infection

Abstract

We evaluated neuropsychological test performance of 168 homosexual and bisexual men with and without human immunodeficiency virus (HIV) infection (113 HIV+ subjects and 55 HIV- controls) over 4.5 years of semiannual follow-up. Analyses of the longitudinal data were performed by applying generalized estimating equations (GEEs) to regression analyses with repeated measures. Compared with the HIV- men, the HIV+ subjects performed more poorly on memory testing. Performance on all tests tended to improve over time, but this improvement was attenuated or eliminated in the HIV+ group for tests of language and attention. Within the HIV+ subjects, improvement over time in tests of memory, executive function, language, and attention was attenuated or eliminated in patients with lower CD4 levels; more advanced HIV disease was associated with poorer memory and executive function and with attenuated or reduced learning effects for memory, motor speed, and language tests. Clinically significant neurologic findings were associated with worse memory and orientation and with attenuated or reversed learning effects for memory, language, and attention tests. There were 33 deaths in the HIV+ group. In the men who died, there was more rapid decline in executive, language, and attentional test performance. These observations remained significant after controlling for HIV disease severity. We conclude that HIV infecting the CNS results in progressive cognitive change that is closely associated with neurologic findings. In addition, our findings suggest a relation between more rapid cognitive progression and death.

Stability of mood despite HIV illness progression in a group of homosexual men

“…It is of interest that Stern et al (20), studying the same group, found a significant, "relatively subtle" (p. 471) decline in cognitive functioning with progressive illness, while we found no association between psychopathology and illness progression. These findings suggest that the data set, despite notable and nonrandom attrition, can produce evidence of decline associated with progressive illness when it does occur, supporting the validity of our negative findings.…”

Influence of Lymphocyte T CD4 Levels on the Neuropsychological Performance of Population A ected by HIV and with a Previous History of Substance Use

“…These results are in accordance with those obtained in other studies with drug addict subjects during the different stages of infection [8] [28], as well as those obtained with homosexual subjects [4] [18] [29], which describe problems of attention, verbal fluency and manual dexterity.…”

Neuropsychiatric Correlates of Memory-Metamemory Dissociations in HIV-Infection

“…Using the current standard for clinical staging of HIV disease (Center for Disease Control, 1992 [CDC93]), recent reviews of the literature suggest that 35% of asymptomatic (CDC93-A), 44% of mildly symptomatic (CDC93-B), and 55% of persons with acquired immunodeficiency syndrome (AIDS; CDC93-C) exhibit neurocognitive impairments, particularly in the areas of attention, speed of information processing, learning efficiency, and psychomotor skills White et al, 1995). At least initially, the pattern of neurocognitive impairments associated with HIV-infection is characteristic of a 'subcortical' neurologic process (Cummings, 1990), but with progression in systemic disease and severe immunosuppression, additional disruption in executive (frontal lobe) brain systems can occur (Bornstein et al, 1993;Law et al, 1994;Marcotte et al, 1996;Sahakian et al, 1995;Stern, Silva, Chaisson, & Evans, 1996;Stern et al, 1995).…”