367. Use of a Brief Task-Based Measure to Assess the Functional Consequences of Cognitive Impairment in HIV

Abstract

BackgroundIn spite of viral suppression with antiretroviral therapy (ART), neurocognitive impairment (NCI) affects ~20% of those infected with HIV; most are asymptomatic or only mildly impaired based on instrumental activity of daily living (IADL) self-reported questionnaires. Previous studies have shown a strong association between depression, common among HIV+, and self-reported IADL impairment, potentially confounding evaluation of the functional impact of NCI. We studied a brief (15–20 minutes) task-based measure of function, the Texas Functional Living Scale (TFLS), in the context of HIV, NCI, and depression.MethodsBaseline data were analyzed from parallel, longitudinal cohort studies of neurocognitive function among HIV+ and demographically matched HIV-subjects enrolled at NIH and DoD sites. Subjects recruited at NIH were on ART with viral suppression (VS) ≥1 year and nearly all in the DoD also had long-term VS. All participants underwent a standardized, comprehensive neurocognitive battery (7 domains), as well as the TFLS. Global deficit score (GDS) ≥0.5 defined neurocognitive impairment (NCI) and TFLS impairment was defined as T-score >1 standard deviation below mean (i.e., < 40).Results420 subjects were evaluated with demographics in Table 1. Eighty-five subjects (20%) had NCI by GDS and 57 (13%) subjects had TFLS impairment. 17% had a Beck Depression Inventory II (BDI) score ≥13 indicating significant depressive symptoms. In univariate analysis of Table 1 variables, only HIV status was not significantly different between those with or without TFLS impairment, however after adjustment using multivariable logistic regression, only education level, race, and NCI were associated with TFLS impairment; depressive symptoms (BDI ≥13) were not associated with functional impairment measured by TFLS.ConclusionIn parallel DoD and NIH cohorts of well-treated HIV+ and matched HIV- subjects, task-based functional impairment measured by TFLS was strongly associated with NCI, but not with depressive symptoms, suggesting the potential utility of this measure to better understand the functional consequences of HIV associated neurocognitive disorders. While the association of TFLS with education was expected, that with race was not and requires further study. Disclosures All authors: No reported disclosures.