Applying the HIV-associated neurocognitive disorder diagnostic criteria to HIV-infected youth

Hoare, Jacqueline; Phillips, Nicole; Joska, John A.; Paul, Robert; Donald, Kirsten A.; Stein, Dan J.; Thomas, Kevin G. F.

doi:10.1212/wnl.0000000000002669

Cited by 55 publications

(49 citation statements)

References 34 publications

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“…In addition, it is quick and easily performed in busy clinic settings. We found a prevalence of neurocognitive impairment of 56% using y-IHDS, similar to the 45% of HIV+ youth that met criteria for neurocognitive disorder diagnosis through an extensive battery of neurocognitive tests in the same setting [38]. However, in other African settings, the adult IHDS score overestimated the burden of neurocognitive impairment [39].…”

Section: Discussionsupporting

confidence: 60%

Multisystem impairment in South African adolescents with Perinatally acquired HIV on antiretroviral therapy (ART)

et al. 2019

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Introduction Adolescents with perinatally acquired HIV ( PHIV ) are at risk of chronic disease due to long‐standing immune suppression, HIV disease and antiretroviral therapy ( ART ) exposure. However, there are few data on multisystem disease in this population. We investigated the overlapping burden of neurocognitive, cardiovascular, respiratory and/or renal impairment among PHIV positive ( PHIV +) adolescents. Methods In this cross‐sectional analysis, participants aged 9 to 14 years on ART for >6 months were recruited from seven sites across Cape Town from July 2013 through March 2015, together with age‐matched HIV‐negative ( HIV‐ ) adolescents. Impairment at enrolment was assessed across neurocognitive functioning (using the youth‐International HIV Dementia Scale); cardiac function (echocardiogram abnormality); respiratory function (abnormal spirometry) and renal function (abnormal glomerular filtration rate). Results and Discussion Overall, 384 PHIV + and 95 HIV‐ adolescents were included (mean age, 11.9 years; 49% female). Median age of ART initiation was 4.2 years ( IQR : 1.7 to 7.6) and median CD 4 count was 709 ( IQR : 556 to 944) with 302 (79%) of PHIV + adolescents virologically suppressed. Abacavir and Zidovudine were the most commonly used nucleoside reverse transcriptase inhibitors ( NRTI s) with 60% of adolescents on non‐nucleoside reverse transcriptase inhibitors ( NNRTI ) and 38% on a protease inhibitor ( PI ). Among PHIV + adolescents, 167 (43.5%) had single system impairment only, 110 (28.6%) had two systems involved, and 39 (10.2%) had three or four systems involved. PHIV + participants had more 2‐system and 3‐system impairment than HIV‐ , 110 (28.6%) versus 17 (17.9%), p = 0.03 and 39 (10.2%) versus 3 (4.3%), p = 0.03. PHIV + participants who had failed a year of school (73.8% vs. 46.4%, p = 0.00) and with a viral load >1000 copies/mL at enrolment (16.8% vs. 8.1%, p = 0.03) were more likely to have dual or multisystem impairment. Of those with cardiac impairment, 86.7% had an additional system impaired. Similarly, in those with neurocognitive impairment, almost 60% had additional systems impaired and of t...

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Section: Discussionsupporting

confidence: 60%

Multisystem impairment in South African adolescents with Perinatally acquired HIV on antiretroviral therapy (ART)

et al. 2019

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“…In Western and industrialized nations, the presence of HIV-associated cognitive impairment is an independent risk factor for treatment failure, functional disability, and early mortality. [2][3][4][5] Although the most severe forms of HIV-associated cognitive impairment are rare in children treated with antiretroviral therapy (ART), milder forms of cognitive impairment have persisted. [4][5][6] It is not clear why cognitive impairment persists despite effective viral suppression.…”

Section: Introductionmentioning

confidence: 99%

Brain Magnetic Resonance Imaging Findings Associated With Cognitive Impairment in Children and Adolescents With Human Immunodeficiency Virus in Zambia

Dean

Buda

Adams

et al. 2020

Pediatric Neurology

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Background: Cognitive impairment is common in children and adolescents with human immunodeficiency virus (HIV). Brain magnetic resonance imaging (MRI) is a potentially useful tool to investigate the pathophysiology of HIV-associated cognitive impairment and may serve as a biomarker in future clinical trials. There are few published data on brain imaging in children with HIV in sub-Saharan Africa. Methods: Thirty-four perinatally infected subjects with HIV and age-matched HIV-exposed uninfected controls between the ages nine and 17 years were recruited from the Pediatric Center of Excellence in Lusaka, Zambia, as part of the HIV-associated Neurocognitive Disorders in Zambia study. Brain MRI sequences were acquired, and clinical and volumetric assessments were performed. Subjects underwent a comprehensive neuropsychologic battery, and cognitive impairment status was classified using a global deficit score approach. Regression models were used to evaluate relationships between MRI findings and cognitive function. Results: We identified cerebrovascular disease in seven of 34 subjects with HIV compared with zero of 17 controls (21% vs 0%, P ¼ 0.04). We also identified decreased total brain volumes (1036 vs 1162 cm 3 , P ¼ 0.03) and decreased cortical thickness in the right temporal lobes (3.12 vs 3.29 mm; P ¼ 0.01) and right fusiform gyri (3.10 vs 3.25 mm; P ¼ 0.02) of HIV-infected subjects with cognitive impairment. Conclusions: These findings support the hypothesis that brain volumes may be useful biomarkers for cognitive outcomes in children with HIV. Further studies are necessary to investigate mechanisms of cerebrovascular disease and volume loss in children with HIV.

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“…Approximately 30%-50% of adults meet criteria for HIV-associated neurocognitive disorders (HAND) (Heaton et al, 2011). The few studies of HAND in youth living with HIV (YLWH), report rates between 40% and 70% (Hoare et al, 2016;Loft et al, 2014;Nichols et al, 2013). HAND represent biologically-based cognitive stressors that have the potential to overwhelm cognitive processes.…”

Section: Introductionmentioning

confidence: 99%

Promoting resilience through neurocognitive functioning in youth living with HIV

et al. 2018

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Using a phased model of intervention development, we developed an intervention to promote resilience in youth living with HIV via improved neurocognitive resources. First, youth completed a naturalistic prospective memory (PM) task and were randomized into a visualization condition or control condition. Next, 47 of these participants completed another naturalistic PM task and were randomized into Calendaring condition, an Alarm condition, a Combined condition, or a Control condition. Youth with low PM demonstrated observable gains from the visualization technique. Youth in the Combined Calendaring and Alarm condition demonstrated significantly better performance than participants in the Control and Calendaring conditions. In a Proof-of-Concept study with 16 youth, the previous findings were translated into a single session inperson intervention followed by tailored text messaging to improve adherence and viral load via improved neurocognitive resources. The resulting intervention showed a signal of effect with viral load reductions in youth with available data. Targeting compensatory strategies to enhance neurocognitive functioning may promote resilience and health outcomes. A randomized pilot study with a control condition is the next step.

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Applying the HIV-associated neurocognitive disorder diagnostic criteria to HIV-infected youth

Cited by 55 publications

References 34 publications

Multisystem impairment in South African adolescents with Perinatally acquired HIV on antiretroviral therapy (ART)

Multisystem impairment in South African adolescents with Perinatally acquired HIV on antiretroviral therapy (ART)

Brain Magnetic Resonance Imaging Findings Associated With Cognitive Impairment in Children and Adolescents With Human Immunodeficiency Virus in Zambia

Promoting resilience through neurocognitive functioning in youth living with HIV

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