Neurocognitive disorders in positive HIV patients
Preliminary data of a Uruguayan prospective cohort
Abstract
Introduction: the incidence of mild and moderate neurocognitive disorders (NCDs) in HIV patients continues to increase in spite of antiretroviral therapy (ART). Only a few studies in the region focused on HIV associated NCDs.
Objective: to describe the characteristics of NCDs patients, identify posible etiologies and decide whether to start the search.
Method: transversal study with a prospective collection of data. HIV positive patients between 18 and 60 years old with no structural defects of the central nervous system (CNS) were consecutively recruited. Laboratory tests were applied as well as screening for CNS, the Instrumental activities of daily living (IADLs) scale, the International HIV Dementia Scale (IHDS), and the Adenbrooke’s Cognitive Examination revised exam (ACE-R). The latter was chosen as the reference test for neurocognitive performance. The Beck Depression inventory (BDI) was used to identify drepression. Statistical analysis was conducted with the SPSS system.
Results and discussion: 20 patients were recruited, NCD was diagnosed in 9 out of 20 patients (45%). Treating physicians spoke about NCD in 2 of the 9 patients. Multivariate analysis revealed an association between unemployment (p=0.012) and a lower schooling rate (p=0.035) in patients with NCDs. Etiology of NCD was multifactorial in all 9 patients. 8 out of 9 patients were referred as NCDs in the screening. IHDS was appropriate to identify severe NCDs, although it failed in mild cases. Also, IADLs failed to identify a few cases of NCDs. Conclusions: almost half of the patients presented multifactorial NCDs, associated to unemployment and a lower rate of schooling. Treating physicians did not consider this diagnosis, what reflects the importance of a systematic neuropsychological assessment in HIV patients.
References
(1) Airoldi M, Bandera A, Trabattoni D, Tagliabue B, Arosio B, Soria A, et al. Neurocognitive impairment in HIV-infected naive patients with advanced disease: the role of virus and intrathecal immune activation. Clin Dev Immunol 2012; 2012:1-5.
(2) Grupo de expertos del Grupo de Estudio de Sida, Secretaría del Plan Nacional sobre el Sida. Documento de consenso sobre el manejo clínico de los trastornos neurocognitivos asociados a la infección por el virus de inmunodeficiencia humana. Enferm Infecc Microbiol Clin 2014; 32(1):37-47.
(3) Blackstone K, Moore DJ, Franklin DR, Clifford DB, Collier AC, Marra CM, et al. Defining neurocognitive impairment in HIV: deficit scores versus clinical ratings. Clin Neuropsychol 2012; 26(6):894-908.
(4) Devlin KN, Gongvatana A, Clark US, Chasman JD, Westbrook ML, Tashima KT, et al. Neurocognitive effects of HIV, hepatitis C, and substance use history. J Int Neuropsychol Soc 2012; 18(1):68-78.
(5) Han L, Enquan X, Jianuo L, Huangui X. Oligodendrocyte injury and pathogenesis of HIV-1-associated neurocognitive disorders. Brain Sci 2016; 6(23):1-14.
(6) Heaton RK, Clifford DB, Franklin DR, Woods SP, Ake C, VaidaF, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology 2010; 75:2087-96.
(7) Simioni S, Cavassini M, Annoni JM, Rimbault Abraham A, Bourquin I, Schiffer V, et al. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS 2010; 24(9):1243-50.
(8) Tsegaw M, Andargie G, Alem G, Tareke M. Screening HIV-associated neurocognitive disorders (HAND) among HIV positive patients attending antiretroviral therapy in South Wollo, Ethiopia. J Psychiatr Res 2017; 85:37-41.
(9) Elbirt D, Mahlab-Guri K, Bezalel-Rosenberg S, Gill H, Attali M, Asher I. HIV-associated neurocognitive disorders (HAND). Isr Med Assoc J 2015; 17:54-9.
(10) Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology 2007; 69(18):1789-99.
(11) Silva MM. Neurologic complications of HIV in the HAART era: where are we? Braz J Infect Dis 2012; 16(4):373-8.
(12) Vance DE. Prevention, rehabilitation, and mitigation strategies of cognitive deficits in aging with HIV: implications for practice and research. ISRN Nurs 2013:1-21.
(13) Vance DE, McDougall GJ, Wilson N, Debiasi MO, Cody SL. Cognitive consequences of aging with HIV: implications for neuroplasticity and rehabilitation. Top Geriatr Rehabil 2014; 30(1):35-45.
(14) Doyle K, Morgan E, Morris S, Smith D, Little S, Ludicello J, et al. Real-world impact of neurocognitive deficits in acute and early infection. J Neurovirol 2013; 19(6):565-73.
(15) Kelly CM, van Oosterhout JJ, Ngwalo C, Stewart RC, Benjamin L, Robertson KR, et al. HIV associated neurocognitive disorders (HAND) in Malawian adults and effect on adherence to combination anti-retroviral therapy: a cross sectional study. PLos One 2014; 9(6):1-11.
(16) Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, Leblanc S, 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.
(17) Blackstone K, Moore DJ, Heaton RK, Franklin DR, Woods SP, Clifford BD, et al. Diagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning. J Int Neuropsychol Soc 2012; 18(1):79-88.
(18) Zhang Y, Qiao L, Ding W, Wei F, Zhao Q, Wang X, et al. An initial screening for HIV-associated neurocognitive disorders of HIV-1 infected patients in China. J Neurovirol 2012; 18(2):120-6.
(19) Sacktor NC, Wong M, Nakasujja N, Skolasky RL, Selnes OA, Musisi S, et al. The Internacional HIV Dementia Scale: a new rapid screening test for HIV dementia. AIDS 2005; 19:1367-74.
(20) Smith B, Skolasky R. The International HIV Dementia Scale as a screening tool for all forms of HIV-associated neurocognitive disorders. En: 19th Conference on Retroviruses and Opportunistic Infections. 5-8 march 2012. Seattle, WA: 2012 (Abstact 505).
(21) Penalva de Oliveira AC, Vidal Bermudez JE. Algoritmo para o diagnóstico e tratamento das alterac¸ões neurocognitivas em pacientes HIV/aids 2012. En: Carvalho de Mello e Silva AC, coord. Guia de investigação, manejo e prevenção das comorbidades associadas ao HIV. 2a. ed Sao Paulo: Instituto de Infectología Emilio Rivas, 2013:123-34.
(22) Cross S, Önen N, Gase A, Overton ET, Ances BM. Identifying risk factors for HIV-associated neurocognitive disorders using the international HIV dementia scale. J Neuroimmune Pharmacol 2013; 8(5):1114-22.
(23) Robbins RN, Remien RH, Mellins CA, Joska JA, Stein DJ. Screening for HIV-associated dementia in South Africa: potentials and pitfalls of task-shifting. AIDS Patient Care STDS 2011; 25(10):587-93.
(24) Torralva T, Roca M, Gleichgerrcht E, Bonifacio A, Raimondi C, Manes F. Validation of the spanish version of the Addenbrooke’s Cognitive Examination-Revised (ACE-R) Neurología 2011; 26(6):351-6.
(25) Sarasola D, de Luján-Calcagno M, Sabe L, Crivelli L, Torralva T, Roca M, et al. Validity of the spanish version of the Addenbrooke’s Cognitive Examination for the diagnosis of dementia and to differentiate Alzheimer’s disease and frontotemporal dementia. Revi Neurol 2005; 41:717-21.
(26) Mathuranath PS, Nestor PJ, Berrios GE, Rakowicz W, Hodges JR. A brief cognitive test battery to differentiate Alzheimer’s disease and frontotemporal dementia. Neurology 2000; 55:1613-20.
(27) Cattie JE, Doyle K, Weber E, Grant I, Woods SP. Planning deficits in HIV-associated neurocognitive disorders: component processes, cognitive correlates, and implications for everyday functioning. J Clin Exp Neuropsychol 2012; 34(9):906-18.
(28) Woods S, Weber E, Weisz B, Twamley E, Grant I. Prospective memory deficits are associated with unemployment in persons living with HIV infection. Rehabil Psychol 2011; 56(1):77-84.
(29) Wang Z, Zheng Y, Liu L, Shen Y, Zhang R, Wang J, et al. High prevalence of HIV-associated neurocognitive disorder in HIV-infected patients with a baseline CD4 count = 350 cells/μL in Shanghai, China. BioSci Trends 2013; 7(6):284-9.
(30) Lake JE, Vo QT, Jacobson LP, Sacktor N, Miller EN, Post WS, et al. Adiponectin and interleukin-6, but not adipose tissue, are associated with worse neurocognitive function in HIV-infected men. Antivir Ther 2015; 20(2):235-44.
(31) Morgan EE, Woods SP, Smith C, Weber E, Scott JC, Grant I. Lower cognitive reserve among individuals with syndromic HIV-associated neurocognitive disorders (HAND). AIDS Behav 2012; 16(18):2279-85.
(32) Folstein MF, Folstein SE, McHugh PR. «Mini-mental state». A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189-98.
(33) Rodrigues RA, Oliveira RL, Grinsztejn B, Silva MT. Validity of the International HIV dementia Scale in Brazil. Arq Neuropsiquiatr 2013; 71(6):376-9.
(34) Ku NS, Lee Y, Ahn JY, Song JE, Kim MH, Jeong SJ, et al. HIV-associated neurocognitive disorder in HIV-infected Koreans: the Korean NeuroAIDS Project. HIV Med 2014; 15(8):470-7.
(35) Nightingale S, Winston A, Letendre S, Michael BD, McArthur JC, Khoo S, et al. Controversies in HIV-associated neurocognitive disorders. Lancet Neurol 2014; 13(11):1139-51.
(36) Uruguay. Ministerio de Salud, Ministerio de Desarrollo Social. Día mundial de lucha contra el VIH/SIDA. Año 2016. Montevideo: MSP, 2016.
(37) McGuire JL, Gill AJ, Douglas SD, Kolson DL. Central and peripheral markers of neurodegeneration and monocyte activation in HIV-associated neurocognitive disorders. J Neurovirol 2015; 21:439-48.
(38) Fogel G, Lamers S, Levine A, Valdes-Sueiras M, McGrath M, Shapshak P, et al. Factors related to HIV-associated neurocognitive impairment differ with age. J Neurovirol 2015; 21(1):56-65.
(39) Hong S, Banks W. Role of the immune system in HIV-associated neuroinflammation and neurocognitive implications. Brain Behav Immun 2015; 45:1-12.
(40) Meade C, Conn N, Skalski L, Safren S. Neurocognitive impairment and medication adherence in HIV patients with and without cocaine dependence. J Behav Med 2011; 34(2):128-38.
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