Real-world impact of neurocognitive deficits in acute and early HIV infection

Doyle, Katie; Morgan, Erin E.; Morris, Sheldon R.; Smith, Davey M.; Little, Susan J.; Iudicello, Jennifer E.; Blackstone, Kaitlin; Moore, David J.; Grant, Igor; Letendre, Scott; Woods, Steven Paul

doi:10.1007/s13365-013-0218-2

Cited by 49 publications

(44 citation statements)

References 46 publications

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“…In addition, attention should be paid to whether observed changes in cognition associated with cancer therapies impact daily life functioning of patients. Although evidence suggests that performance on neuropsychological tests is related to aspects of everyday functioning, such as employment, medication adherence, and financial management, 92,114,115 none of the current studies on the potential effects of endocrine therapies evaluated these aspects.…”

Section: Discussionmentioning

confidence: 99%

Cognitive effects of endocrine therapy for breast cancer: keep calm and carry on?

et al. 2015

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The number of breast cancer survivors is gradually increasing and a subset of these patients experience long-term adverse effects of adjuvant systemic therapy, including cognitive decline. Surprisingly, relatively little is known about the long-term adverse effects of endocrine treatment on cognition. As 75% of all patients with breast cancer are eligible to receive hormonal treatment, understanding the potential neurocognitive adverse effects of such therapy is of utmost importance. Concerns about adverse cognitive effects of adjuvant endocrine therapy are timely, as recently updated guidelines recommend increasing the length of such therapy from 5 years to 10 years for a subset of patients. The decline of cognitive functions can have a detrimental impact on quality of life and might interfere with independent living. This Review discusses the tissue-selective side effects of endocrine therapies and specifically their impact on cognitive function, on the basis of clinical data; the neurobiological effects of endocrine therapies as observed in preclinical models are also discussed. We highlight the critical issues that need to be addressed in future preclinical and clinical studies in order to best assess the cognitive effects of endocrine treatment in patients with breast cancer.

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Section: Discussionmentioning

confidence: 99%

Cognitive effects of endocrine therapy for breast cancer: keep calm and carry on?

et al. 2015

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“…Although there are no widely agreed upon clinical measures of daily functioning (Marcotte 2009), ANI appears to put the individual at risk for subsequent deficits in day-to-day functioning (Doyle 2013). …”

Section: Introductionmentioning

confidence: 99%

The HIV-1 transgenic rat model of neuroHIV

Vigorito

Connaghan

Chang

2015

Brain, Behavior, and Immunity

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Despite the ability of current combination anti-retroviral therapy (cART) to limit the progression of HIV-1 to AIDS, HIV-positive individuals continue to experience neuroHIV in the form of HIV-associated neurological disorders (HAND), which can range from subtle to substantial neurocognitive impairment. NeuroHIV may also influence substance use, abuse, and dependence in HIV-positive individuals. Because of the nature of the virus, variables such as mental health co-morbidities make it difficult to study the interaction between HIV and substance abuse in human populations. Several rodent models have been developed in an attempt to study the transmission and pathogenesis of the HIV-1 virus. The HIV-1 transgenic (HIV-1Tg) rat is a reliable model of neuroHIV because it mimics the condition of HIV-infected patients on cART. Research using this model supports the hypothesis that the presence of HIV-1 viral proteins in the central nervous system increases the sensitivity and susceptibility of HIV-positive individuals to substance abuse.

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“…About 35% to 60% of persons with AEH show neurocognitive difficulties, most of them mild. These impairments fall midway between those of HIV-seronegative and chronically infected populations (eg, Doyle et al, 2013; Moore et al, 2011; Wang et al, 2011; Weber et al, 2013). …”

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confidence: 97%

“…Neurocognitive deficits in AEH have been found in the domains of working memory, information processing speed, and learning (Doyle et al, 2013; Moore et al, 2011; Wang et al, 2011). These impairments have clinical implications, as they are a primary risk factor for dependence in several aspects of daily function, including the ability to hold a job (Doyle et al, 2013).…”

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confidence: 99%

Neurobehavioral Disturbances During Acute and Early HIV Infection

Kamat

Doyle

Iudicello

et al. 2016

Cognitive and Behavioral Neurology

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Background and Objective Acute and early human immunodeficiency virus infection (AEH) is accompanied by neuroinflammatory processes as well as impairment in neurocognitive and everyday functions, but little is known about the frequency and clinical correlates of the neurobehavioral disturbances during this period. We compared pre-seroconversion with current levels of apathy, disinhibition, and executive dysfunction; we also examined everyday function and HIV disease correlates of neuropsychiatric impairment in individuals with AEH. Methods In this study, 34 individuals with AEH and 39 HIV-seronegative participants completed neuromedical and neuropsychological assessments, a structured psychiatric interview, and the apathy, disinhibition, and executive dysfunction subscales of the Frontal Systems Behavioral Scale. Results Independent of any substance use and mood disorders, the AEH group had significantly higher levels of current apathy and executive dysfunction than the controls, but not greater disinhibition. Retrospective ratings of pre-seroconversion levels of apathy, disinhibition, and executive dysfunction were all higher in the AEH group than the controls. After seroconversion, the AEH cohort had increases in current apathy and executive dysfunction, but not disinhibition. In the AEH cohort, higher current global neurobehavioral dysfunction was significantly associated with lower nadir CD4 counts, slowed information processing speed, and more everyday function problems. Conclusions These data suggest that individuals who have recently acquired HIV experienced higher-than-normal premorbid levels of neurobehavioral disturbance. Apathy and executive dysfunction are exacerbated during AEH, particularly in association with lower CD4 counts.

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Real-world impact of neurocognitive deficits in acute and early HIV infection

Cited by 49 publications

References 46 publications

Cognitive effects of endocrine therapy for breast cancer: keep calm and carry on?

Cognitive effects of endocrine therapy for breast cancer: keep calm and carry on?

The HIV-1 transgenic rat model of neuroHIV

Neurobehavioral Disturbances During Acute and Early HIV Infection

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