BackgroundCardiovascular disease (CVD) and premature aging have been hypothesized as new risk factors for HIV associated neurocognitive disorders (HAND) in adults with virally-suppressed HIV infection. Moreover, their significance and relation to more classical HAND biomarkers remain unclear.Methods92 HIV− infected (HIV+) adults stable on combined antiretroviral therapy (cART) and 30 age-comparable HIV-negative (HIV−) subjects underwent 1H Magnetic Resonance Spectroscopy (MRS) of the frontal white matter (targeting HIV, normal aging or CVD-related neurochemical injury), caudate nucleus (targeting HIV neurochemical injury), and posterior cingulate cortex (targeting normal/pathological aging, CVD-related neurochemical changes). All also underwent standard neuropsychological (NP) testing. CVD risk scores were calculated. HIV disease biomarkers were collected and cerebrospinal fluid (CSF) neuroinflammation biomarkers were obtained in 38 HIV+ individuals.ResultsRelative to HIV− individuals, HIV+ individuals presented mild MRS alterations: in the frontal white matter: lower N-Acetyl-Aspartate (NAA) (p<.04) and higher myo-inositol (mIo) (p<.04); in the caudate: lower NAA (p = .01); and in the posterior cingulate cortex: higher mIo (p<.008– also significant when Holm-Sidak corrected) and higher Choline/NAA (p<.04). Regression models showed that an HIV*age interaction was associated with lower frontal white matter NAA. CVD risk factors were associated with lower posterior cingulate cortex and caudate NAA in both groups. Past acute CVD events in the HIV+ group were associated with increased mIo in the posterior cingulate cortex. HIV duration was associated with lower caudate NAA; greater CNS cART penetration was associated with lower mIo in the posterior cingulate cortex and the degree of immune recovery on cART was associated with higher NAA in the frontal white matter. CSF neopterin was associated with higher mIo in the posterior cingulate cortex and frontal white matter.ConclusionsIn chronically HIV+ adults with long-term viral suppression, current CVD risk, past CVD and age are independent factors for neuronal injury and inflammation. This suggests a tripartite model of HIV, CVD and age likely driven by chronic inflammation.

The Australian HIV-infected (HIV+) population is largely comprised of high-functioning men who have sex with men (MSM). Like other English-speaking countries, Australia mostly relies on US neuropsychological normative standards to detect and determine the prevalence of neurological disorders. Whether the US neuropsychological (NP) normative standards are appropriate in Australian HIV+ MSM has not been established. Ninety virally suppressed HIV+ and 49 HIV-uninfected (HIV−) men (respectively 86 and 85 % self-reported MSM; mean age 54 and 56 years, mean premorbid verbal IQ estimate 110 and 111) undertook standard NP testing. The raw neuropsychological data were transformed using the following: (1) US standards as uncorrected scaled scores and demographically corrected T scores (US norms); and (2) z scores (without demographic corrections) derived from Australian comparison group scaled scores (local norms). To determine HIV-associated neurocognitive disorder prevalence, we used a standard definition of impairment based upon a battery-wide summary score: the global deficit score (GDS). Impairment classification (GDS≥0.5) based on the local norms was best at discriminating between the two groups (HIV−=14.3 % vs. HIV+ = 53.3 %; p<0.0001). This definition was significantly associated with age. Impairment classification based on the US norms yielded much lower impairment rate regardless of the HIV status (HIV−=4.1 % vs. HIV+=14.7 %; p= 0.05), but was associated with historical AIDS, and not age. Both types of summary scores were associated with reduced independence in activities of daily living (p≤ 0.03). Accurate neuropsychological classifications of high (or low) functioning individuals may need country-specific norms that correct for performance-based (e.g., reading) estimates of premorbid cognition in addition to the traditional demographic factors.

Clinically stable HIV+ individuals show a mild level of emotional processing reduction that is dissociated from neuropsychiatric complaints. Individuals with HAND showed moderate to large emotional processing abnormalities, particularly for the timely recognition of negative expressions (fear, sadness, and anger). These findings warrant a more comprehensive and dynamic evaluation of emotional processing in HIV infection and an investigation of the integrity of the fronto-basal-amygdala circuits.

Disability awareness training that delivered relevant information by involving guest speakers with a disability, included documentary evidence about the lives of people with a disability, and included interactive discussion, was successful. CATCH and "Just Like You" are useful tools for measuring self-reported attitudes about disability.

The focus of this paper is on the assessment of the two main processes that children must acquire at the single word reading level: word recognition (lexical) and decoding (nonlexical) skills. Guided by the framework of the dual route model, this study aimed to (1) investigate the impact of item characteristics on test performance, and (2) determine to what extent widely used reading measures vary in their detection of lexical and nonlexical reading difficulties. Thirty children with reading difficulties were administered selected reading subtests from the Woodcock-Johnson III, the Wechsler Individual Achievement Test – Second Edition, the Castles and Coltheart Reading Test 2 (CC2), as well as a measure of nonverbal IQ. Both within-subjects analyses and descriptive data are presented. Results suggest that in comparison to a pure measure of irregular word reading, children with reading difficulties perform better on word identification subtests containing both regular and irregular word items. Furthermore, certain characteristics (e.g., length, similarity to real words) appear to influence the level of difficulty of nonword items and tests. The CC2 subscales identified the largest proportions of children with reading difficulties. Differences between all test scores were of statistical and clinical significance. Clinical and theoretical implications are discussed.