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.

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Slide via:  http://goo.gl/kzIo48

Apathy Is Associated with Lower Mental and Physical Quality of Life in Persons Infected with HIV

HIV infection is associated with lower health-related quality of life (HRQoL), which is influenced by immunovirological factors, negative affect, neurocognitive impairment, and functional dependence. Although apathy is a common neuropsychiatric sequela of HIV infection, emerging findings regarding its unique role in lower HRQoL have been mixed. 

The present study was guided by Wilson and Cleary's (1995), model in examining the association between apathy and physical and mental HRQoL in 80 HIV+ individuals who completed a neuromedical examination, neuropsychological assessment, structured psychiatric interview, and a series of questionnaires including the SF-36. Apathy was measured using a composite of the apathy subscale of the Frontal Systems Behavioral Scale and the vigor-activation subscale of the Profile of Mood States. 

Independent of major depressive disorder, neurocognitive impairment, functional status, and current CD4 count, apathy was strongly associated with HRQoL. Specifically, apathy and CD4 count were significant predictors of physical HRQoL, whereas apathy and depression were the only predictors of mental HRQoL. 

All told, these findings suggest that apathy plays a unique role in HRQoL and support the importance of assessing and managing apathy in an effort to maximize health outcomes among individuals with HIV disease.

Purchase full article at:   http://goo.gl/2t95BY

By:  Kamat R1, Woods SP1,2, Cameron MV1, Iudicello JE1; HIV Neurobehavioral Research Program (HNRP) Group.

• 1 Department of Psychiatry , University of California , San Diego , CA , 92093 , USA.
• 2 Department of Psychology , University of Houston , Houston , TX , 77004 , USA 

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Sleep, Fatigue, and Problems with Cognitive Function in Adults Living with HIV

Up to 50% of people living with HIV have some neurocognitive impairment. We examined associations of sleep and fatigue with self-reported cognitive problems in 268 adults living with HIV. 

Multivariate regression was used to examine associations between cognitive problems, self-reported sleep quality, actigraphy-measured total sleep time and wake after sleep onset, and fatigue severity. Poorer self-reported sleep quality (p < .001), short or long total sleep time (<7 or >8 vs. 7-8 hours, p = .015), and greater fatigue (p < .001) were associated with lower self-reported cognitive function scores after controlling for demographic and clinical characteristics. However, objective measure of wake after sleep onset was unrelated to self-reported cognitive function scores. F

indings suggest that assessing and treating poor sleep and complaints about fatigue would be areas for intervention that could have a greater impact on improving cognition function than interventions that target only cognitive problems.

Purchase full article at:  http://goo.gl/Wk2bWV

By:  Byun E, Gay CL, Lee KA.

 

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The Role of Depression Chronicity & Recurrence on Neurocognitive Dysfunctions in HIV-Infected Adults

Research assessing whether major depressive disorders (MDD) impacts neurocognitive functions in HIV+ persons has yielded inconsistent results. However, none have considered the role of MDD remission, chronicity, and stability on treatment. 

Ninety-five HIV+ adults clinically stable on combined antiretroviral treatment completed a psychiatric interview, a depression scale, a neuropsychological, daily living, and cognitive complaints assessments at baseline and 18 months. Participants were screened for current (within 12 months of study entry) alcohol and/or substance use disorder. History of alcohol and/or substance abuse disorder prior to the 12 months entry screen and MDD treatments were recorded. Participants were grouped into two psychiatric nomenclatures: (1) lifetime: no MD episode (MDE), single MDE life-event treated and fully remitted, chronic MDD treated and stable, chronic MDD treated and unstable, and baseline untreated MDE; (2) recent: last 2 years MDE (yes or no). 

We found that lifetime and recent psychiatric history were more strongly associated with decreased in independence in daily living and cognitive complaints than with baseline neuropsychological performance. However, lack of full remission, instability on treatment in chronic MDD, and severity of symptoms in current MDE were factors in whether MDD impacted baseline neuropsychological performance. Depressive symptoms improved at follow-up in those with baseline moderate-severe symptoms, and MDD was not associated with neurocognitive change at 18 months. A history of alcohol and/or substance abuse disorder was significantly more frequent in those with treated and unstable chronic MDD but it was not associated with neuropsychological performance. 

MDD recurrence, chronicity profiles, and associated comorbidities are keys factors to understand any potential impact on neurocognitive abilities in HIV infection. More comprehensive consideration of these complex effects could serve at constructively updating the HAND diagnostic criteria.

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