Aging and HIV/AIDS: Neurocognitive Implications for Older HIV-Positive Latina/o Adults

Abstract

In recent years, HIV/AIDS populations have become older and increasingly more ethnically diverse. Concurrently, the prevalence of HIV-related neurocognitive (NC) impairment remains high. This study examined the effects of age and ethnicity on NC function in HIV-positive adults. The sample (N = 126; 84 Latina/o and 42 Non-Hispanic White) completed a comprehensive NC battery. Global NC and domain average demographically-corrected t-scores were generated. There were no significant differences between Younger (<50 years) Latina/os and non-Hispanic Whites on Global NC function or NC domains (all p's >.10), with generally small effect sizes. Older Latina/os (≥50 years) were significantly more impaired than Older Non-Hispanic Whites on Correspondence should be addressed to Monica Rivera Mindt, PhD, ABPP-CN, Fordham University, Department of Psychology-DE 322, New York, NY 10024, USA. riveramindt@fordham.edu. 2009. 3,4 Estimates suggest that these trends will continue, 4 and will contribute to the "graying of HIV." HHS Public AccessDespite advancements in treatment, recent research indicates that the prevalence of HIVassociated neurocognitive disorders (HAND) continue to remain as high as 52%, similar to rates reported in the pre-cART era. 5 Emerging evidence further suggests that older PLWH may be at even higher risk for developing HAND, although this literature remains somewhat equivocal (Cherner et al., 2004;Valcour, 2004). 6,7 A number of factors may potentially confer increased risk of neurocognitive decline in older PLWH, including increased risk for cardiovascular and cerebrovascular pathology, immunological changes, and expression of apolipoprotein E4 (APOE4), among others. 8 However, the potential interactions of aging and HIV disease remain poorly understood. 8The risk factors for neurocognitive decline are especially salient for older racial/ethnic minority PLWHA, and this remains an understudied and poorly understood area. Not only has the HIV/AIDS population become older overall, but this population has also become increasingly ethnically diverse. In the US, the Latina/o population is disproportionately impacted by the HIV/AIDS epidemic. Among people 50 years or older in the US, Latina/os are five times as likely as their white counterparts to be living with HIV, 3 and once infected, the HIV-seropositive Latina/o population carries greater disease burden compared to nonHispanic white adults. 9 For instance, HIV-seropositive Latina/o adults have a higher mortality rate, are more likely to die at significantly younger ages, and demonstrate significantly worse executive functioning (even after accounting for relevant covariates such as reading level which is a proxy for quality of education) compared to their non-Hispanic White counterparts. 10,11,12,13 The general US Latina/o population also suffers from myriad other health disparities, including higher rates of stroke, diabetes, obesity, and hypertension. 10,14,15 Within an aging, HIV-seropositive, and ethnically diverse urban cohort similar to tha...