Abstract
BackgroundThrough implementation of combination antiretroviral therapy (cART) remarkable gains have been achieved in the management of HIV infection; nonetheless, the neurocognitive consequences of infection remain a pivotal concern in the cART era. Research has often employed norm-referenced neuropsychological scores, derived from healthy populations (excluding many seronegative individuals at high risk for HIV infection), to characterize impairments in predominately male HIV-infected populations.MethodsUsing matched-group methodology, we assessed 81 HIV-seropositive (HIV+) women with established neuropsychological measures validated for detection of HIV-related impairments, as well as additional detailed tests of executive function and decision-making from the Cambridge Neuropsychological Test Automated Battery (CANTAB).ResultsOn validated tests, the HIV+ women exhibited impairments that were limited to significantly slower information processing speed when compared with 45 HIV-seronegative (HIV−) women with very similar demographic backgrounds and illness comorbidities. Additionally, select executive impairments in shifting attention (i.e., reversal learning) and in decision-making quality were revealed in HIV+ participants. Modifiers of neurocognition in HIV-infected women included detectable HIV plasma viral load, active hepatitis C virus co-infection, and self-reported depression symptoms. In contrast, leukocyte telomere length (LTL), a marker of cellular aging, did not significantly differ between HIV+ and HIV− women, nor was LTL associated with overall neurocognition in the HIV+ group.ConclusionsThe findings suggest that well-managed HIV infection may entail a more circumscribed neurocognitive deficit pattern than that reported in many norm-referenced studies, and that common comorbidities make a secondary contribution to HIV-related neurocognitive impairments.
Highlights
Despite advances in HIV antiretroviral treatment (ART), namely the advent of combination ART, HIV infection continues to be linked to deleterious functional and structural consequences for brain parenchyma [1,2,3,4,5,6,7,8]
A recent meta-analysis revealed lesser attentional, motor, and executive skill impairments in HIV+ individuals treated with combination antiretroviral therapy (cART) relative to monotherapy [12]
Impairment profiles vary amongst HIV+ individuals [13], deficits in speed of information processing [14,15,16], fine motor speed and dexterity [17,18], aspects of learning and memory [19,20,21,22,23], and multiple domains of executive functioning [17,24,25,26,27,28,29,30] are commonly identified
Summary
Despite advances in HIV antiretroviral treatment (ART), namely the advent of combination ART (cART), HIV infection continues to be linked to deleterious functional and structural consequences for brain parenchyma [1,2,3,4,5,6,7,8]. Estimates indicate that as many as 50% of HIV+ individuals display some degree of neurocognitive dysfunction when impairment is derived from comparisons with normative performance standards (e.g., [9,10,11]). A recent meta-analysis revealed lesser attentional, motor, and executive skill impairments in HIV+ individuals treated with cART relative to monotherapy [12]. Poorer quality of care in women is associated with younger age, substance use/IDU, lower annual income, and low trust in care providers [38,39]. These factors may directly or indirectly modify the HIV-related neurocognitive deficits observed. Research has often employed norm-referenced neuropsychological scores, derived from healthy populations (excluding many seronegative individuals at high risk for HIV infection), to characterize impairments in predominately male HIV-infected populations
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