Poorer neuropsychological performance increases risk for social services among HIV-infected individuals.

HIV-Associated Neurocognitive Disorder (HAND) is a prevalent condition among persons with HIV resulting in cognitive impairments that may impact daily functioning. The relationship between neuropsychological (NP) test performance and functional status was investigated based on social services received (SSR) among 285 HIV-infected and 242 HIV-negative participants enrolled in the Hawai'i Aging with HIV Cohort. HIV-infected participants scored significantly lower than the HIV-negative group on all measures of NP testing and also reported receiving SSR at a higher rate. Among HIV-infected participants, more SSR correlated with poorer overall global NP performance (ρ = -0.25, P < .001), as well as poorer performance in NP domains assessing psychomotor speed (ρ = -0.25, P < .001), and learning and memory (ρ = -0.19, P = .02). NP test performance did not correlate with the number of SSR among HIV-negative participants. Supplemental Security Income (SSI) was the most commonly utilized social service among HIV-infected. Receiving SSI was associated on multivariate analysis with poorer NP performance independent of lack of full time work, or nadir CD4 count. Poorer NP performance among HIV-infected individuals is associated with increased risk for social services. Interventions to address causes of cognitive dysfunction in this population may decrease demand for social services.

Cerebrovascular risk factors and brain microstructural abnormalities on diffusion tensor images in HIV-infected individuals.

HIV-associated neurocognitive disorder remains prevalent in HIV-infected individuals despite effective antiretroviral therapy. As these individuals age, comorbid cerebrovascular disease will likely impact cognitive function. Effective tools to study this impact are needed. This study used diffusion tensor imaging (DTI) to characterize brain microstructural changes in HIV-infected individuals with and without cerebrovascular risk factors. Diffusion-weighted MRIs were obtained in 22 HIV-infected subjects aged 50 years or older (mean age = 58 years, standard deviation = 6 years; 19 males, three females). Tensors were calculated to obtain fractional anisotropy (FA) and mean diffusivity (MD) maps. Statistical comparisons accounting for multiple comparisons were made between groups with and without cerebrovascular risk factors. Abnormal glucose metabolism (i.e., impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus) was associated with significantly higher MD (false discovery rate (FDR) critical p value = 0.008) and lower FA (FDR critical p value = 0.002) in the caudate and lower FA in the hippocampus (FDR critical p value = 0.004). Pearson correlations were performed between DTI measures in the caudate and hippocampus and age- and education-adjusted composite scores of global cognitive function, memory, and psychomotor speed. There were no detectable correlations between the neuroimaging measures and measures of cognition. In summary, we demonstrate that brain microstructural abnormalities are associated with abnormal glucose metabolism in the caudate and hippocampus of HIV-infected individuals. Deep gray matter structures and the hippocampus may be vulnerable in subjects with comorbid abnormal glucose metabolism, but our results should be confirmed in further studies.