Perceived and posttraumatic stress is associated with decreased learning, memory, and fluency in HIV-infected women

Abstract

Design Multi-center, prospective cohort study Methods Every two years between 2009 and 2013 (3 times), 646 HIV+ and 300 demographically-similar HIV-uninfected (HIV-) women from the Women’s Interagency HIV Study completed neuropsychological (NP) testing and questionnaires measuring PRFs (perceived stress, post-traumatic stress disorder (PTSD) symptoms, depressive symptoms). Using mixed-effects regressions, we examined separate and interactive associations between HIV-serostatus and PRFs on performance over time. Results HIV+ and HIV- women had similar rates of PRFs. Fluency was the only domain where performance over time depended on the combined influence of HIV-serostatus and stress or PTSD (p’s<0.05); not depression. In HIV, higher stress and PTSD were associated with a greater cognitive decline in performance (p’s<0.05) versus lower stress and PTSD. Irrespective of time, performance on learning and memory depended on the combined influence of HIV-serostatus and stress or PTSD (p’s≤0.05). In the context of HIV, stress and PTSD were negatively associated with performance. Effects were pronounced on learning among HIV+ women without effective treatment or viral suppression. Regardless of time or HIV-serostatus, all PRFs were associated with lower speed, global NP, and executive function. Conclusions More than depression, perceived stress and PTSD symptoms are treatment targets to potentially improve fluency, learning, and memory in women living with HIV particularly when HIV treatment is not optimal.

Global estimate of the prevalence of post-traumatic stress disorder among adults living with HIV: a systematic review and meta-analysis

“…But the lack of studies with other groups lowered the generalisability and global relevance of their findings. Moreover, the meta-analysis was conducted in 2012, and the increase of publications about PTSD among PLWH since then24–26 suggests that a timely update is urgently needed. Indeed, several reviews provide a useful overview of the possible prevalence of PTSD among PLWH22 27; however, a number of gaps remain.…”

Elevated Depressive Symptoms Are a Stronger Predictor of Executive Dysfunction in HIV-Infected Women Than in Men

“…In the WIHS, current MDD via diagnostic interview was 20% and lifetime MDD was 32% versus 10% and 23% nationally 13 . In cognitive studies, about 30% of WIHS women report elevated depressive symptoms, [16][17][18] an estimate about 10% higher than other large-scale cohort studies of healthy midlife women [19][20][21] . Additionally, HIV+ women often have higher rates of depression 22 and more depressive symptoms than HIV+ men 7,[23][24][25] .…”

“…Among HIV-uninfected (HIV-) individuals, depression severity is commonly associated with poorer episodic memory, executive function, psychomotor speed, and attention 27 . Across cross-sectional studies in PWH, the domains most reliably associated with depression are psychomotor speed (50% of studies), executive function (45%), learning and memory (42%), and motor function (44%) 28 followed by attention and working memory (38% 29 . In the MACS, depression is also associated with psychomotor speed (SDMT) and executive function (TMT-B minus TMT-A); however, other domains have not been examined 30 .…”

“…Biological mechanisms that may contribute to sex differences in the depression-NCI relationship include, among others, sex differences in neuroinflammation [31][32][33] , dopamine transmission 34 , genetics 35 and the HPA axis 36,37 . Given our prior work demonstrating an HIV by sex interaction on NCI (attention/psychomotor speed, motor function) 1 and given that depression influences many of those domains (attention, executive function) 29,30 , we hypothesized that depression would predict greater HIV-related NCI in females versus men, particularly in attention, executive function, and motor function.…”

The relationship between potentially traumatic or stressful events, HIV infection and neurocognitive impairment (NCI): a systematic review of observational epidemiological studies

“…Regarding verbal fluency, five studies demonstrated an association with PTEs and SLEs (Malan-Muller Pukay-Martin et al, 2003;Rubin et al, 2017;Spies et al, 2016Spies et al, , 2017Watson et al, 2019). For attention/working memory, seven studies demonstrated an association with trauma (Clark et al, 2018;Kapetanovic et al, 2020;Lin et al, 2011;Pukay-Martin et al, 2003;Spies et al, 2016;Watson et al, 2019;Womersley et al, 2019); four studies demonstrated an association with processing speed, (Clark et al, 2012;Pukay-Martin et al, 2003;Spies et al, 2016; six studies demonstrated an association with learning (Rubin et al, 2017(Rubin et al, , 2015Spies et al, 2016Watson et al, 2019) while three studies demonstrated an association with motor function (Pukay-Martin et al, 2003;Spies et al, 2016;Womersley et al, 2019). Two studies (Deiss et al, 2019;Pukay-Martin et al, 2003) reported an association between global NCI and trauma (i.e.…”