Advertisement

Neurocognitive Functioning in Antiretroviral Therapy–Naïve Youth With Behaviorally Acquired Human Immunodeficiency Virus

      Abstract

      Purpose

      Youth living with human immunodeficiency virus (HIV) account for over one third of new HIV infections and are at high risk of adverse psychosocial, everyday living, and health outcomes. Human immunodeficiency virus–associated neurocognitive disorders (HAND) are known to affect health outcomes of HIV-infected adults even in the era of combination antiretroviral therapy. Thus, the current study aimed to characterize the prevalence and clinical correlates of HAND in youth living with HIV. Here, we report baseline neurocognitive data for behaviorally HIV-infected youth enrolled in a prospective study evaluating strategies of antiretroviral treatment initiation and use.

      Methods

      A total of 220 participants, age 18–24 years, who were naive to treatment (except for prevention of mother-to-child HIV transmission; n = 3), completed a comprehensive neurocognitive, substance use, and behavioral health assessment battery.

      Results

      Sixty-seven percent of youth met criteria for HAND (96.4% were asymptomatic and 3.5% were syndromic); deficits in episodic memory and fine-motor skills emerged as the most commonly affected ability areas. Multivariable models showed that lower CD4 count, longer time since HIV diagnosis, and high-risk alcohol use were uniquely associated with neurocognitive deficits.

      Conclusions

      Over two thirds of youth with behaviorally acquired HIV evidence neurocognitive deficits, which have modest associations with more advanced HIV disease as well as other factors. Research is needed to determine the impact of such neuropsychiatric morbidity on mental health and HIV disease treatment outcomes (e.g., nonadherence) and transition to independent living responsibilities in HIV-infected youth, as well as its long-term trajectory and possible responsiveness to cognitive rehabilitation and pharmacotherapy.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Centers for Disease Control. HIV among youth. CDC HIV/AIDS Facts. December 2011. Available at http://www.cdc.gov/hiv/pdf/library_factsheet_HIV_amongYouth.pdf. Accessed August 16, 2013.

        • Tanney M.R.
        • Naar-King S.
        • Murphy D.A.
        • et al.
        Multiple risk behaviors among youth living with human immunodeficiency virus in five U.S. cities.
        J Adolesc Health. 2010; 46: 11-16
        • Eaton D.K.
        • Kann L.
        • Kinchen S.
        • et al.
        Youth risk behavior surveillance—United States, 2011.
        MMWR Surveill Summ. 2012; 61: 1-162
        • Woods S.P.
        • Moore D.J.
        • Weber E.
        • Grant I.
        Cognitive neuropsychology of HIV-associated neurocognitive disorders.
        Neuropsychol Rev. 2009; 19: 152-168
        • Loveland K.A.
        • Stehbens J.A.
        • Mahoney E.M.
        • et al.
        Declining immune function in children and adolescents with hemophilia and HIV infection: Effects on neuropsychological performance. Hemophilia Growth and Development Study.
        J Pediatr Psychol. 2000; 25: 309-322
        • Allison S.
        • Wolters P.
        • Brouwers P.
        Youth with HIV/AIDS: Neurobehavioral consequences.
        in: Paul R.H. Sacktor N. Valcour V. Tashima K.T. HIV and the Brain: New Challenges in the Modern Era. Humana Press, New York2009: 187-211
        • Heaton R.K.
        • Franklin D.R.
        • Ellis R.J.
        • et al.
        HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: Differences in rates, nature, and predictors.
        J Neurovirol. 2011; 17: 3-16
        • Fama R.
        • Rosenbloom M.J.
        • Nichols B.N.
        • et al.
        Working and episodic memory in HIV infection, alcoholism, and their comorbidity: Baseline and 1-year follow-up examinations.
        Alcohol Clin Exp Res. 2009; 33: 1815-1824
        • Rippeth J.D.
        • Heaton R.K.
        • Carey C.L.
        • et al.
        Methamphetamine dependence increases risk of neuropsychological impairment in HIV infected persons.
        J Int Neuropsychol Soc. 2004; 10: 1-14
        • Ellis R.
        • Badiee J.
        • Vaida F.
        • et al.
        Nadir CD4 is a predictor of HIV neurocognitive impairment in the era of combination antiretroviral therapy.
        AIDS. 2011; 25: 1747-1751
        • Morgan E.E.
        • Woods S.P.
        • Smith C.
        • et al.
        Lower cognitive reserve among individuals with syndromic HIV-Associated Neurocognitive Disorders (HAND).
        AIDS Behav. 2012; 16: 2279-2285
        • Hinkin C.H.
        • Castellon S.A.
        • Durvasula R.S.
        • et al.
        Medication adherence among HIV+ adults: Effects of cognitive dysfunction and regimen complexity.
        Neurology. 2002; 59: 1944-1950
        • Hosek S.G.
        • Zimet G.D.
        Behavioral considerations for engaging youth in HIV clinical research.
        J Acquir Immune Defic Syndr. 2010; 54: S25-S30
        • Blakemore S.J.
        • Choudhury S.
        Development of the adolescent brain: Implications for executive function and social cognition.
        J Child Psychol Psychiatry. 2006; 47: 296-312
        • Antinori A.
        • Arendt G.
        • Becker J.T.
        • et al.
        Updated research nosology for HIV-associated neurocognitive disorders.
        Neurology. 2007; 69: 1789-1799
        • Brandt J.
        • Benedict R.
        Hopkins Verbal Learning Test–Revised.
        Psychological Assessment Resources, Odessa (FL)2001
        • Norman M.A.
        • Moore D.J.
        • Taylor M.
        • et al.
        Demographically corrected norms for African Americans and Caucasians on the Hopkins Verbal Learning Test–Revised, Brief Visuospatial Memory Test-Revised, Stroop Color and Word Test, and Wisconsin Card Sorting Test 64-Card Version.
        J Clin Exp Neuropsychol. 2011; 33: 793-804
        • Benedict R.
        Brief visuospatial memory test–revised.
        Psychological Assessment Resources, Odessa (FL)1997
        • Strauss E.
        • Sherman E.M.S.
        • Spreen O.
        A compendium of neuropsychological tests: Administration, norms, and commentary.
        Oxford University Press, New York (NY)2006
        • Robertson K.R.
        • Parsons T.D.
        • Sidtis J.J.
        • et al.
        Timed Gait test: Normative data for the assessment of the AIDS dementia complex.
        J Clin Exp Neuropsychol. 2006; 28: 1053-1064
        • The Psychological Corporation
        WAIS-III/WMS-III technical manual.
        Psychological Corporation, San Antonio (TX)1997
        • Golden C.J.
        • Freshwater S.M.
        The Stroop Color and Word Test: a manual for clinical and experimental uses.
        Stoelting Co., Wood Dale (IL)2002
        • Reitan R.M.
        • Wolfson D.
        The Halstead-Reitan neuropsychological test battery: Theory and clinical interpretation.
        2nd ed. Neuropsychology Press, Tucson (AZ)1993
        • Mitrushina M.
        • Boone K.
        • Razani J.
        • D’Elia L.
        Handbook of normative data for neuropsychological assessment.
        Oxford University Press, New York (NY)2005
        • Wilkinson G.S.
        • Robertson G.J.
        Wide Range Achievement Test administration manual.
        4th ed. Wide Range, Inc, Wilmington (DE)2006
        • Heaton R.
        • Marcotte T.
        • Mindt M.
        • et al.
        The impact of HIV-associated neuropsychological impairment on everyday functioning.
        J Int Neuropsychol Soc. 2004; 10: 317-331
        • Roth A.T.
        • Isquith P.K.
        • Gioia G.A.
        Behavior Rating Inventory of Executive Function—Adult Version: Professional manual.
        Psychological Assessment Resources, Inc, Lutz (FL)2007
        • Heaton R.K.
        • Clifford D.B.
        • Franklin Jr., D.R.
        • et al.
        HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study.
        Neurology. 2010; 75: 2087-2096
        • Carey C.L.
        • Woods S.P.
        • Gonzalez R.
        • et al.
        Predictive validity of global deficit scores in detecting neuropsychological impairment in HIV infection.
        J Clin Exp Neuropsychol. 2004; 26: 307-319
        • Beck A.T.
        • Steer R.A.
        • Brown G.K.
        Beck Depression Inventory manual.
        2nd ed. Psychological Corporation, Harcourt Brace & Company, San Antonio (TX)1987
        • Derogatis L.R.
        Brief Symptom Inventory (BSI): Administration, scoring, and procedures manual.
        3rd ed. National Computer Systems, Inc, Minneapolis (MN)1993
        • World Health Organization ASSIST Working Group
        The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Development, reliability and feasibility.
        Addiction. 2002; 97: 1183-1194
        • Centers for Disease Control
        1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults.
        MMWR Recomm Rep. 1992; 41: 1-19
        • Thompson M.A.
        • Aberg J.A.
        • Hoy J.F.
        • et al.
        Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel.
        JAMA. 2012; 308: 387-402
        • Gongvatana A.
        • Woods S.P.
        • Taylor M.J.
        • et al.
        Semantic clustering inefficiency in HIV-associated dementia.
        J Neuropsychiatry Clin Neurosci. 2007; 19: 36-42
        • Smith R.
        • Chernoff M.
        • Williams P.L.
        • et al.
        Impact of HIV severity on cognitive and adaptive functioning during childhood and adolescence.
        Pediatr Infect Dis J. 2012; 31: 592-598
        • Moore D.J.
        • Letendre S.L.
        • Morris S.
        • et al.
        Neurocognitive functioning in acute or early HIV infection.
        J Neurovirol. 2011; 17: 50-57
        • Squeglia L.M.
        • Pulido C.
        • Wetherill R.R.
        • et al.
        Brain response to working memory over three years of adolescence: Influence of initiating heavy drinking.
        J Stud Alcohol Drugs. 2012; 73: 749-760
        • Ettenhofer M.L.
        • Foley J.
        • Castellon S.A.
        • Hinkin C.H.
        Reciprocal prediction of medication adherence and neurocognition in HIV/AIDS.
        Neurology. 2010; 74: 1217-1222
        • Anand P.
        • Springer S.A.
        • Copenhaver M.M.
        • Altice F.L.
        Neurocognitive impairment and HIV risk factors: A reciprocal relationship.
        AIDS Behav. 2010; 14: 1213-1226
        • Basso M.R.
        • Bornstein R.A.
        Estimated premorbid intelligence mediates neurobehavioral change in individuals infected with HIV across 12 months.
        J Clin Exp Neuropsychol. 2000; 22: 208-218
        • Woods S.P.
        • Dawson M.S.
        • Weber E.
        • Grant I.
        The semantic relatedness of cue-intention pairings influences event-based prospective memory failures in older adults with HIV infection.
        J Clin Exp Neuropsychol. 2010; 32: 398-407