The importance of cognitive self-report in early HIV-1 infection: validation of a cognitive functional status subscale.

BACKGROUND: The Medical Outcomes Study HIV (MOS-HIV) Health Survey is a widely used instrument to assess quality of life in HIV-1-infected individuals. Its cognitive functional status subscale measures functional status owing to neuropsychological (NP) impairment. OBJECTIVES: To determine the concurrent validity of the Dutch four-item MOS-HIV cognitive functional status subscale and its clinical significance in predicting NP test performance. DESIGN: Cross-sectional analysis of baseline data collected between October, 1994, and March, 1997, in the Netherlands and in Flanders, Belgium. SUBJECTS: A total of 85 HIV-1-infected homosexual men who participated in an ongoing longitudinal research project designed to study the effects of a support group. RESULTS: The MOS-HIV cognitive functional status subscale showed significant associations with NP test performance overall and, specifically, with the domains of abstraction, language and visuospatial abilities, controlling for CD4 cell count and Centers for Disease Control and Prevention (CDC) clinical disease stage. A trend toward significance was also found in the memory domain. CONCLUSIONS: To our knowledge, this is the first report of a cognitive functional status subscale used with HIV-1-infected subjects in a language other than English. The MOS-HIV cognitive functional status subscale seems particularly sensitive to changes in NP test performance in early HIV-1 infection. These results suggest the potential for clinical utility of a brief functional status self-report measure related to cognitive abilities in early HIV-1 infection for the screening and diagnosis of HIV-1 associated cognitive-motor disorders.

Older age and plasma viral load in HIV-1 infection.

BACKGROUND: The purpose of the study was to examine the relationship between age and plasma viral load in HIV-1-infected individuals. DESIGN: The experimental method was to recruit older (> 50 years of age) and younger (18-39 years of age) HIV-1-infected individuals. The plasma viral load was measured using the Roche Molecular Systems UltraSensitive Roche HIV-1 Monitor test reflexively with the standard Amplicor HIV Monitor test to quantify viral load in the range of 50-750,000 copies of HIV-1 RNA/ml plasma. SUBJECTS: A total of 135 HIV-1-seropositive individuals (at Centers for Disease Control and Prevention early symptomatic stage B or late symptomatic stage/AIDS C) were enrolled as part of a larger cohort also consisting of HIV-1-seronegative individuals. RESULTS: A generalized linear models statistical analysis was conducted in order to evaluate age category as a predictor of plasma viral load. The result was a significant effect of age category, with older age associated with a lower plasma viral load. The association held controlling for antiretroviral therapy usage, disease stage, antiretroviral medication adherence, HIV-1 serostatus duration, alcohol and substance use, recent sexually transmitted disease, and sociodemographics (except income). CONCLUSION: Older age was associated with lower levels of HIV-1 replication in this sample, independent of antiretroviral therapy usage, regimen adherence, and disease stage. It is suggested that the effect may be caused by changes in viral evolution or immunological monitoring specific to older individuals with HIV-1 infection.

Neurocognitive aspects of medication adherence in HIV-positive injecting drug users.

Cognitive deficits are associated with nonadherence to HIV medications. HIV-positive injecting drug users (IDUs) are at particular risk for nonadherence and cognitive barriers to adherence specific to this population should therefore be identified. The present study assessed the relation of three domains of cognitive functioning, executive functions, memory, and psychomotor speed, to self-reported antiretroviral adherence in a sample of HIV-positive IDUs. Depression, use of alcohol, heroin, cocaine/crack, or marijuana in the last week were also included in the models. Logistic regression analyses showed that only psychomotor slowing was significantly associated with nonadherence. Executive functions, memory, depression, and active alcohol and substance use were unrelated to adherence. No other studies to date have exclusively linked psychomotor slowing to nonadherence in HIV infection. Psychomotor slowing among our study sample was severe and suggests that when evident, such slowing may be a valuable determinant for antiretroviral adherence among IDUs.

Cerebrospinal and peripheral human immunodeficiency virus type 1 load in a multisite, randomized, double-blind, placebo-controlled trial of D-Ala1-peptide T-amide for HIV-1-associated cognitive-motor impairment.

D-Ala1-peptide T-amide (DAPTA) has shown neuroprotection in vitro against gp120-induced loss of dendritic arborization and is promulgated as a CCR5 antagonist. A multisite, randomized, double-blind clinical trial of DAPTA versus placebo prior to combination antiretroviral therapy conducted with human immunodeficiency virus (HIV)-1 seropositive participants having cognitive impairment showed no overall cognitive effect, though subgroups with greater impairment and CD4 cell counts of 201 to 500 cells/mm3 at baseline showed significant improvement. The objective of this study was to examine whether intranasal administration of DAPTA at a dose of 2 mg three times per day (tid) was associated with a reduction of cerebrospinal fluid (CSF) and peripheral (plasma and serum) viral load among a subgroup of participants completing 6 months of treatment. Baseline and 6-month CSF (n = 92) and peripheral (plasma n = 33; serum n = 24) viral load were measured by the Roche Ultrasensitive assay, version 1.5, with reflexive use of the AMPLICOR assay and preservation of the blind. A DAPTA treatment indicator variable was tested using generalized linear models on change in viral load. Peripheral load (combined plasma and serum) was significantly reduced in the DAPTA-treated group. No group differences in CSF viral load were found. This retrospective study on a limited subgroup of the original trial sample indicated that DAPTA treatment may reduce peripheral viral load without concomitant CSF effects. Future studies should be undertaken to confirm the existence of this result and the CSF-periphery dissociation observed with respect to HIV-1-associated cognitive-motor impairment.

Cognitive functioning in younger and older HIV-1-infected adults.

In young adults, a major neurologic complication of HIV-1 infection is cognitive motor impairment. Epidemiologic findings suggest that increasing age is a significant risk factor for HIV-1-associated dementia as the AIDS-defining illness. Findings from the few studies that have directly measured cognition in younger and older HIV-1-infected adults, however, have been mixed, in part, because of small sample sizes and other methodologic differences between studies. The authors present preliminary findings on cognitive functioning in symptomatic HIV-1-infected younger (aged 20-39 years) and older (aged 50 years or older) adults. Independent of age, HIV-1 infection was accompanied by learning and memory retrieval deficits, which were significantly associated with high plasma viral loads in the young adults. Relative to the younger and older HIV-1-negative (HIV-1-) groups, only the younger HIV-1-positive (HIV-1+) group had significantly longer reaction times (RTs). Within the older HIV-1+ group, however, longer simple and choice RTs were significantly correlated with higher viral loads and lower CD4 cell counts. Although HIV-1 infection affects cognition independent of age, longitudinal studies involving large numbers of older individuals are needed to determine whether there are age differences in the prevalence, nature, and severity of HIV-1-associated cognitive dysfunction.

HUMANS: An English and Spanish neuropsychological test battery for assessing HIV-1-infected individuals--initial report.

A neuropsychological battery for testing HIV-1-infected individuals in Spanish was developed. We refer to this battery as the HIV/University of Miami Annotated Neuropsychological test battery in Spanish (HUMANS). The HUMANS battery includes recommendations of the National Institute of Mental Health Neuropsychology Workgroup on HIV-1 infection and measures processes in the following 7 cognitive domains: attention, verbal and visual memory, information processing speed, abstraction and executive functioning, language, visuospatial and visuoconstructive, and motor. Administration requires approximately 3 to 4 hr. The English version of the battery is sensitive to HIV-1 serostatus and Centers for Disease Control clinical disease stage. We report on the test selection, translation, and adaptation of this parallel English battery into Spanish using methods to eliminate linguistically and culturally biased items in some tests. The importance of standardized neuropsychological instruments equivalent in different languages to test HIV-1-positive individuals for impairment is emphasized. Validation and reliability studies are in progress.