Screening for Neurocognitive Impairment in HIV-Infected Individuals at First Contact after HIV Diagnosis: The Experience of a Large Clinical Center in Northern Italy

Neurocognitive disorders are emerging, probably underestimated, complications in HIV-infected people. The aim of the study was to assess neurocognitive profiles of newly detected HIV-infected patients. 

We performed an observational retrospective single-cohort study. Illiterates and patients with neurologic symptoms or previous psychiatric diagnosis were excluded. Neuropsychological profiles were assessed using a validated battery of neuropsychological tests. 

We included 206 patients; with males representing the majority of them (85%). Risk factors for HIV acquisition were unprotected sexual intercourse (homo/bisexual in 39.8% and heterosexual in 60.2%). Thirty-nine patients (18.9%) were previous injection drug users, while 41 (19.9%) were alcohol abusers. Mean education was 11.1 years (SD-standard deviation-3.7). 

A high prevalence of HIV-associated neurocognitive disorders (HAND, 47.1%) was present in HIV-infected patients: particularly, asymptomatic neurocognitive impairment (ANI) was found in 30.6%, mild neurocognitive disorder (MND) in 15% and HIV-associated dementia (HAD) in 1.5%. 

Male gender, low degree of education, AIDS diagnosis and gepatitis B virus (HBV) co-infection were factors independently associated with HAND in a multivariable logistic regression model. 

Our data suggest that patient-specific factors and AIDS diagnosis have a certain kind of impact in HAND occurrence. A complete neuropsychological screening must be recommended in all patients at HIV-infection diagnosis.

Full article at:  http://goo.gl/vb0hz3

By:  Focà E1, Magro P2, Motta D3, Compostella S4, Casari S5, Bonito A6, Brianese N7, Ferraresi A8, Rodari P9, Pezzoli MC10, Quiros-Roldan E11, Castelli F12.

• 1Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. emanuelefoca@gmail.com.
• 2Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. p.magro@unibs.it.
• 3Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. davide.motta84@gmail.com.
• 4Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. compostar@hotmail.com.
• 5Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. s.casari@infettivibrescia.it.
• 6Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. andreabonito@hotmail.com.
• 7Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. nigri_bri@libero.it.
• 8Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. alice-ferraresi@hotmail.it.
• 9Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. paolarodari@icluod.com.
• 10Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. chiarapezzoli@yahoo.com.
• 11Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. eugeniaquiros@yahoo.it.
• 12Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy. francesco.castelli@unibs.it. 
• Int J Mol Sci. 2016 Mar 24;17(4). pii: E434. doi: 10.3390/ijms17040434.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Slide via:  http://goo.gl/kzIo48

Murder & Psychosis: Neuropsychological Profiles of Homicide Offenders with Schizophrenia

BACKGROUND:

Neurocognitive dysfunction, a core feature of schizophrenia, is thought to contribute to the impulsive violent aggression manifested by some individuals with schizophrenia, but not enough is known about how homicidal individuals with schizophrenia perform on neuropsychological measures.

AIMS:

The primary aim of our study was to describe the neuropsychological profiles of homicide offenders with schizophrenia. Supplementary analyses compared the criminal, psychiatric and neuropsychological features of schizophrenic homicide offenders with and without God/Satan/demon-themed psychotic symptoms.

METHODS:

Twenty-five men and women diagnosed with schizophrenia who had killed another person - 21 convicted of first-degree murder and 4 found not guilty by reason of insanity - completed neuropsychological testing during forensic evaluations.

RESULTS:

The sample was characterised by extensive neurocognitive impairments, involving executive dysfunction (60%), memory dysfunction (68%) and attentional dysfunction (50%), although those with God/Satan/demon-themed psychotic symptoms performed better than those with nonreligious psychotic content.

CONCLUSIONS:

Our findings indicate that impaired cognition may play an important role in the commission of homicide by individuals with schizophrenia. A subgroup with God/Satan/demon delusions seem sufficiently less impaired that they might be able to engage in metacognitive treatment approaches, aimed at changing their relationship to their psychotic symptoms, thus reducing the perception of power and omnipotence of hallucinated voices and increasing their safety

Purchase full article at:   http://goo.gl/lat1a1

By:  Stratton J1, Brook M1, Hanlon RE1,2.

• 1Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
• 2Neuropsychological Associates of Chicago, Chicago, IL, USA. 
• Crim Behav Ment Health. 2016 Feb 10. doi: 10.1002/cbm.1990.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

HIV and Cognitive Concerns - Video

Via:  http://www.ohtn.on.ca/

Prevalence of HIV-Associated Neurocognitive Disorders in the Multicenter AIDS Cohort Study

OBJECTIVE:

To evaluate the frequency of HIV-associated neurocognitive disorder (HAND) in HIV+ individuals and determine whether the frequency of HAND changed over 4 years of follow-up.

METHODS:

The Multicenter AIDS Cohort Study (MACS) is a prospective study of gay/bisexual men. Beginning in 2007, all MACS participants received a full neuropsychological test battery and functional assessments every 2 years to allow for HAND classification.

RESULTS:

The frequency of HAND for the 364 HIV+ individuals seen in 2007-2008 was 33% and for the 197 HIV+ individuals seen at all time periods during the 2007-2008, 2009-2010, and 2011-2012 periods were 25%, 25%, and 31%, respectively. The overall frequency of HAND increased from 2009-2010 to 2011-2012 (p = 0.048). Over the 4-year study, 77% of the 197 HIV+ individuals remained at their same stage, with 13% showing deterioration and 10% showing improvement in HAND stage. Hypercholesterolemia was associated with HAND progression. A diagnosis of asymptomatic neurocognitive impairment was associated with a 2-fold increased risk of symptomatic HAND compared to a diagnosis of normal cognition.

CONCLUSION:

HAND remains common in HIV+ individuals. However, for the majority of HIV+ individuals on combination antiretroviral therapy with systemic virologic suppression, the diagnosis of HAND is not a progressive condition over 4 years of follow-up. Future studies should evaluate longitudinal changes in HAND and specific neurocognitive domains over a longer time period.

Purchase full article at:   http://goo.gl/VqfQ6S

By:   Sacktor N1, Skolasky RL2, Seaberg E2, Munro C2, Becker JT2, Martin E2, Ragin A2, Levine A2, Miller E2.

• 1From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles. sacktor@jhmi.edu.
• 2From the Department of Neurology, Johns Hopkins Bayview Medical Center (N.S.), and the Departments of Orthopaedic Surgery (R.L.S.) and Psychiatry (C.M.), Johns Hopkins University School of Medicine, Baltimore; the Department of Epidemiology (E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; the Department of Psychiatry (J.T.B.), University of Pittsburgh, PA; the Department of Psychiatry (E.M.), Rush University School of Medicine, Chicago, IL; the Department of Radiology (A.R.), Northwestern University, Evanston, IL; and the Department of Neurology, David Geffen School of Medicine (A.L.), and the Department of Psychiatry (E.M.), University of California, Los Angeles.
• Neurology. 2015 Dec 30. pii: 10.1212/WNL.0000000000002277
• 
  
• More at:  https://twitter.com/hiv insight
• And: http://twitter.com/Prison Health

Rates of Non-Confounded HIV-Associated Neurocognitive Disorders in Men Initiating Combination Antiretroviral Therapy During Primary Infection

OBJECTIVE:

To determine the prevalence of HIV-associated neurocognitive disorders (HAND) in HIV-infected participants who initiated combination antiretroviral therapy (cART) during primary infection.

DESIGN:

Cross-sectional observational study.

METHODS:

HIV-infected men without neuropsychiatric confounds who had initiated cART during primary infection were administered a neuropsychological battery as well as questionnaires evaluating depression and quality of life. Eligibility was determined by a medical examination with history and review of records.

RESULTS:

Twenty-six primarily non-Hispanic white (73%), male (100%) participants were enrolled and underwent neurocognitive assessment. Mean age was 43 (28-71) years, with a median of 17 years of education (13-24). Median current and nadir CD4 T-cell counts were 828 (506-1411) and 359 (150-621) cells/μl. All participants had plasma HIV-1 RNA less than 50 copies/ml. Median duration of cART prior to enrolment was 5.7 years (2.2-9.9). Median global deficit score was 0.17 (0.00-0.60). Only one (4%) participant was impaired.

CONCLUSION:

Rates of HAND in this cohort of HIV-infected men without comorbid conditions who initiated early cART are low. Our findings suggest a possible neuroprotective benefit of early cART and an important contribution of comorbidities to observed HAND prevalence.

Purchase full article at:   http://goo.gl/n0iOHV

By:   Evering TH1, Applebaum A, La Mar M, Garmon D, Dorfman D, Markowitz M.

• 1Aaron Diamond AIDS Research Center, an affiliate of the Rockefeller University bMemorial Sloan-Kettering Cancer Center cIcahn School of Medicine at Mount Sinai, New York, New York, USA. *Current address for Donald Garmon: Columbia University Medical Center, New York, New York, United States of America.

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Neurocognitive Profiles of Methamphetamine Users: Comparison of Those With or Without Concomitant Ketamine Use

OBJECTIVE:

Methamphetamine (MAMP) and ketamine are neurotoxic drugs whose chronic use has been linked with a cognitive decline in some users. This paper aims to assess the possible effect of concomitant ketamine use on the neurocognitive performance of MAMP users.

METHODS:

This study divides 42 MAMP users into MAMP users who use ketamine (MAMP+K, n = 16) and MAMP users who do not use ketamine (MAMP-K, n = 26). The performance of these two groups was compared using the Brief Assessment of Cognition in Schizophrenia (BACS), Conners' Continuous Performance Tests (CPT), the Wisconsin Card Sorting Test (WCST), the Iowa Gambling Task (IGT), and the Barratt Impulsiveness Scale (BIS).

RESULTS:

In comparison to the MAMP-K group, the MAMP+K group showed worse performances in verbal fluency, executive function and composite score in BACS; worse performances in total errors, perseverative errors, nonperseverative errors and conceptual level response in WCST; and greater levels of total scores and novelty-seeking in BIS. Neither the attention function evaluated with CPT nor the decision-making behavior evaluated with IGT was associated with previous ketamine use.

CONCLUSION:

This study detected worse executive function and higher impulsivity level among MAMP users with additional ketamine use versus their counterparts without ketamine use. Further studies with a longitudinal design and a large sample size are necessary to clarify the connection between cognitive deficits and concomitant use of MAMP and ketamine.

Purchase full article at:  http://goo.gl/ZU2AwA

By:  Chen YC1,2, Wang LJ3, Lin SK4, Chen CK1,2.

• 1a Department of Psychiatry , Chang Gung Memorial Hospital , Keelung , Taiwan.
• 2b Chang Gung University School of Medicine , Taoyuan , Taiwan.
• 3c Department of Child and Adolescent Psychiatry , Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung , Taiwan.
• 4d The Taipei City Hospital, Songde Branch , Taipei , Taiwan.

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health

Three-Decade Neurological & Neurocognitive Follow-Up of HIV-1-Infected Patients on Best-Available Antiretroviral Therapy in Finland

Objectives

Is it possible to live without neurocognitive or neurological symptoms after being infected with HIV for a very long time? These study patients with decades-long HIV infection in Finland were observed in this follow-up study during three time periods: 1986–1990, in 1997 and in 2013.

Setting

Patients from greater Helsinki area were selected from outpatient's unit of infectious diseases.

Participants

The study included 80 HIV patients. Patients with heavy alcohol consumption, central nervous system disorder or psychiatric disease were excluded.

Primary and secondary outcome measures

The patients underwent neurological and neuropsychological examinations, MRI of the brain and laboratory tests, including blood CD4 cells and plasma HIV-1 RNA. Neuropsychological examination included several measures: subtests of Wechsler Adult Intelligence Scale, Wechsler Memory Scale-Revised, list learning, Stroop and Trail-Making-B test. The Beck Depression Inventory and Fatigue Severity Scale were also carried out. The obtained data from the three time periods were compared with each other.

Results

Owing to high mortality among the original 80 patients, eventually, 17 participated in all three examinations performed between 1986 and 2013. The time from the HIV diagnosis was 27 (23–30) years. Blood CD4 cells at the diagnosis were 610 (29–870) cells/mm³, and the nadir CD4 168 (4–408) cells/mm³. The time on combined antiretroviral treatment was 13 (5–17) years. 9 patients suffered from fatigue, 5 had polyneuropathy and 3 had lacunar cerebral infarcts. There was a subtle increase of brain atrophy in 2 patients. Mild depressive symptoms were common. The neuropsychological follow-up showed typical age-related cognitive changes. No HIV-associated dementia features were detected.

Conclusions

Polyneuropathy, fatigue and mild depression were common, but more severe neurological abnormalities were absent. These long-term surviving HIV-seropositive patients, while on best-available treatment, showed no evidence of HIV-associated neurocognitive disorder in neuropsychological and neuroradiological evaluations.

Full article at:  http://goo.gl/MF8ese

By:  T Heikinheimo,1 E Poutiainen,1,2 O Salonen,3 I Elovaara,4 and M Ristola5

¹Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland

²Rehabilitation Foundation, Helsinki, Finland

³Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland

⁴Neuroimmunology Unit, Medical School, University of Tampere, Tampere, Finland

⁵Department of Infectious Diseases at Aurora Hospital, Helsinki University Central Hospital, Helsinki, Finland

Correspondence to Dr T Heikinheimo; Email: if.suh@llennoc-omiehnikieh.uttret

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

HIV-Related Cognitive Impairment of Orphans in Myanmar with Vertically Transmitted HIV Taking Antiretroviral Therapy

We determined the effect of perinatally acquired HIV on neurocognition in Myanmar children treated with antiretroviral therapy by comparison to demographically matched seronegative children.

Myanmar has one of the highest HIV-1 prevalence rates in Southeast Asia. Studies from other resource-poor countries have shown that HIV-infected children differ in socioeconomic, nutritional and caregiver status compared to normal controls. Some vertically infected orphans in Myanmar reside separately from HIV-uninfected children in separate orphanages, thus the demographic variables of interest are naturally controlled. This study provides a unique evaluation of the neurocognitive effects of HIV in children, with control over key demographic variables. We hypothesized that HIV-infected orphans would perform significantly worse on cognitive indices compared with HIV-negative orphans.

A battery of cognitive tests sensitive to HIV-associated impairments in children was administered to 28 perinatally acquired HIV-positive children and 31 HIV-negative children from two orphanages in Myanmar; 21 children from each cohort underwent testing at baseline and again after 12 months.

Baseline comparison of the two groups indicated that the HIV-infected children performed poorly across all tests, with significant group differences in executive function, visuospatial reasoning, fine motor dexterity, and visual motor integration. On subsequent testing, both cohorts of children showed improvements across multiple domains, with no significant effect of age at treatment initiation.

Our results demonstrate a strong effect of HIV infection on specific neurocognitive deficits in vertically infected children. Understanding viral and host determinants and timing and choice of antiretroviral therapy on cognition will be critical to preventing cognitive impairment of children with HIV.

Via:  http://ht.ly/SuXlq Purchase full article at:  http://ht.ly/SuXvM 

By: Linn K1, Fay A2, Meddles K3, Isbell S4, Lin PN1, Thair C1, Heaps J5, Paul R6, Mar SS3.

• 1Pediatric Neurology Unit, Yangon Children's Hospital, Yangon, Myanmar.
• 2Department of Pediatric Neurology, Washington University, St. Louis, Missouri
• 3Department of Pediatric Neurology, Washington University, St. Louis, Missouri.
• 4Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri.
• 5Department of Psychology and Behavioral Neuroscience, University of Missouri, St. Louis, Missouri.
• 6Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri.

Does Older Age Confer an Increased Risk of Incident Neurocognitive Disorders among Persons Living with HIV Disease?

This study aimed to determine the combined effects of age and HIV infection on the risk of incident neurocognitive disorders.

A total of 146 neurocognitively normal participants were enrolled at baseline into one of four groups based on age (≤40 years and ≥50 years) and HIV serostatus resulting in 24 younger HIV-, 27 younger HIV+, 39 older HIV-, and 56 older HIV+ individuals. All participants were administered a standardized clinical neuropsychological battery at baseline and 14.3 ± .2 months later.

A logistic regression predicting incident neurocognitive disorders from HIV, age group, and their interaction was significant (χ(2)[4] = 13.56, p = .009), with a significant main effect of HIV serostatus (χ(2)[1] = 5.01, p = .025), but no main effect of age or age by HIV interaction (ps > .10). Specifically, 15.7% of the HIV+ individuals had an incident neurocognitive disorder as compared to 3.2% of the HIV- group (odds ratio = 4.8 [1.2, 32.6]). Among older HIV+ adults, lower baseline cognitive reserve, prospective memory, and verbal fluency each predicted incident neurocognitive disorders at follow-up.

Independent of age, HIV infection confers a nearly fivefold risk for developing a neurocognitive disorder over approximately one year. Individuals with lower cognitive reserve and mild weaknesses in higher-order neurocognitive functions may be targeted for closer clinical monitoring and preventative measures.

Via:  http://ht.ly/Sm8XO 

By: Sheppard DP1, Woods SP1,2, Bondi MW3,4, Gilbert PE5, Massman PJ1, Doyle KL6; HIV Neurobehavioral Research Program (HNRP) Group.

• 1a Department of Psychology , The University of Houston , Houston , TX , USA.
• 2b Department of Psychiatry , The HIV Neurobehavioral Research Program, University of California , San Diego , CA , USA.
• 3c Psychology Service , VA San Diego Healthcare System , San Diego , CA , USA.
• 4d Department of Psychiatry , University of California , San Diego , CA , USA.
• 5e Department of Psychology , San Diego State University , San Diego , CA , USA.
• 6f SDSU/UCSD Joint Doctoral Program in Clinical Psychology , San Diego , CA , USA. 
  
  More at:  https://twitter.com/hiv_insight