Cognitive Functioning In Adults Aging With HIV: A Cross-Sectional Analysis Of Cognitive Subtypes And Influential Factors

Fazeli, Pariya L; Crowe, Michael; Ross, Lesley A.; Wadley, Virginia G.; Ball, Karlene; Vance, David E.

doi:10.14302/issn.2324-7339.jcrhap-13-191

Cited by 40 publications

(24 citation statements)

References 22 publications

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“…Older HIV+ adults (>50 years) in the Hawaii Ageing Cohort were twice as likely as their younger HIV+ counterparts to have HAD after adjusting for other known dementia risk factors 31,32 . Older age has also been associated with increased risk of HAND in several South African cohorts 33,34 ; however, the effect of age on HAND risk is likely confounded by the increased prevalence of cerebrovascular risk factors at older ages 26,35 .…”

Section: Clinical Features Of Handmentioning

confidence: 96%

HIV-associated neurocognitive disorder — pathogenesis and prospects for treatment

et al. 2016

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In the past two decades, several advancements have improved the care of HIV-infected individuals. Most importantly, the development and deployment of combination antiretroviral therapy (CART) has resulted in a dramatic decline in the rate of deaths from AIDS, so that people living with HIV today have nearly normal life expectancies if treated with CART. The term HIV-associated neurocognitive disorder (HAND) has been used to describe the spectrum of neurocognitive dysfunction associated with HIV infection. HIV can enter the CNS during early stages of infection, and persistent CNS HIV infection and inflammation probably contribute to the development of HAND. The brain can subsequently serve as a sanctuary for ongoing HIV replication, even when systemic viral suppression has been achieved. HAND can remain in patients treated with CART, and its effects on survival, quality of life and everyday functioning make it an important unresolved issue. In this Review, we describe the epidemiology of HAND, the evolving concepts of its neuropathogenesis, novel insights from animal models, and new approaches to treatment. We also discuss how inflammation is sustained in chronic HIV infection. Moreover, we suggest that adjunctive therapies -treatments targeting CNS inflammation and other metabolic processes, including glutamate homeostasis, lipid and energy metabolism -are needed to reverse or improve HAND-related neurological dysfunction. Competing interests statementThe authors declare no competing interests. HHS Public AccessAuthor manuscript Nat Rev Neurol. Author manuscript; available in PMC 2016 July 08. Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript chronic infection that can be managed, is associated with a near-normal lifespan and in which opportunistic infections are rare 1 .The first major advancement was an understanding of the direct relationship between HIV replication and subsequent immunological and clinical progression. This finding emphasized the need to completely suppress HIV replication in order to control disease progression.The second major advancement was the development and deployment of combination antiretroviral therapy (CART), which can provide effective systemic suppression of HIV replication. The introduction of CART in the mid-1990s resulted in a 50% decline in the rate of death from AIDS, substantial decreases in rates of maternal-infant transmission, reduced incidence of opportunistic infections, and a 40-50% decrease in the incidence of HIVassociated dementia (HAD), which was previously common and is the most severe form of cognitive impairment associated with the infection 2 .The third major change in the care of HIV+ patients was the ability to monitor the efficacy of CART through the reliable and widespread measurement of CD4 + helper T cells, plasma HIV RNA levels and antiretroviral resistance profiles, all of which are now fully integrated into routine clinical care in the developed world and used to optimize treatment for individual patients. Plasma viral l...

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Section: Clinical Features Of Handmentioning

confidence: 96%

HIV-associated neurocognitive disorder — pathogenesis and prospects for treatment

et al. 2016

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“…In a recent cluster analytic study of adults with HIV ( N = 78; M age = 46.61), Fazeli and colleagues (under review) found that a majority of the sample (59%) was classified as neurocognitively “normal” compared to a demographically similar HIV-negative reference group ( N = 84; M age = 47.93). Age was the most influential correlate of cluster membership (“normal” cluster versus lower performing cluster).…”

Section: Hiv and Cognitionmentioning

confidence: 99%

The Synergistic Effects of HIV, Diabetes, and Aging on Cognition

Vance

Fazeli

Dodson

et al. 2014

Journal of Neuroscience Nursing

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In addition to the obvious health problems and/or physical limitations associated with HIV, diabetes, and aging, each of these are known to independently affect cognitive functioning. While this relationship to cognition does not necessarily mean frank cognitive impairments are inevitable with HIV, diabetes, and aging, it does entail that each of these conditions may lead to poorer cognitive performance compared to younger adults and individuals without HIV and diabetes. Many individuals may be aware of the physical symptoms associated with these diseases, but may be unaware of the cognitive outcomes associated with HIV and diabetes, especially if not controlled by medication and a healthy lifestyle. Additionally, individuals may be unaware of the significance of maintaining optimal cognitive functioning in order to maintain optimal everyday functioning abilities such as driving, cooking, managing medication regimens, and negotiating finances. Given that highly active antiretroviral therapy (HAART) has allowed individuals with HIV to live to reach older adulthood, and that dysglycemia and/or type 2 diabetes can be a metabolic side effect of these medications (Biron et al., 2012; Norbiato, 2012; Raper, 2010), it is reasonable to assume that there is a subset of individuals aging with HIV and diabetes, which may become more prevalent as individuals continue to age with HIV in the coming decades. Thus, the purpose of this article is to inform healthcare providers and researchers about the cognitive outcomes associated with HIV, diabetes, and aging independently within the context of cognitive reserve, and then to examine the potential synergistic effects of these conditions in individuals living with all three (Figure 1). This article also incorporates potential intervention strategies to protect and possibly improve cognitive functioning, or at the very least mitigate cognitive loss, in this population.

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“…Despite viro-immunological efficacy of cART, milder forms of HIV-associated neurocognitive disorders (HAND) still persist (Heaton et al, 2011; Clifford, 2008). The frequency of cognitive symptoms is substantially higher among older PLWH, a population that is rapidly growing due to widespread use of cART (Fazeli, 2015; Justice et al, 2010; Valcour et al, 2004). …”

Section: Introductionmentioning

confidence: 99%

Psychiatric symptom burden in older people living with HIV with and without cognitive impairment: the UCSF HIV over 60 cohort study

et al. 2017

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Psychiatric comorbidities are common in people living with HIV (PLWH) and adversely affect life satisfaction, treatment adherence and disease progression. There are few data to inform the burden of psychiatric symptoms in older PLWH, a rapidly growing demographic in the U.S. We performed a cross-sectional analysis to understand the degree to which symptom burden was associated with cognitive disorders in PLWH over age 60. Participants completed a standardized neuropsychological battery and were assigned cognitive diagnoses using Frascati criteria. We captured psychiatric symptom burden using the Geriatric Depression Scale (GDS) and proxy-informed Neuropsychiatric Inventory-Questionnaire (NPI-Q). Those diagnosed with HIV-associated Neurocognitive Disorders (HAND, n = 39) were similar to those without HAND (n = 35) by age (median = 67 years for each group, p = 0.696), education (mean = 16 years vs. 17 years, p = 0.096), CD4+ T-lymphocyte counts (mean = 520 vs. 579, p = 0.240), duration of HIV (median = 21 years for each group, p = 0.911) and sex (92% male in HAND vs. 97% in non-HAND, p = 0.617). Our findings showed similarities in HAND and non-HAND groups on both NPI-Q (items and clusters) and GDS scores. However, there was a greater overall symptom burden in HIV compared to healthy elder controls (n = 236, p < 0.05), with more frequent agitation, depression, anxiety, apathy, irritability and nighttime behavior disturbances (p < 0.05). Our findings demonstrate no differences in psychiatric comorbidity by HAND status in older HIV participants; but confirm a substantial neurobehavioral burden in this older HIV-infected population.

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Cognitive Functioning In Adults Aging With HIV: A Cross-Sectional Analysis Of Cognitive Subtypes And Influential Factors

Cited by 40 publications

References 22 publications

HIV-associated neurocognitive disorder — pathogenesis and prospects for treatment

HIV-associated neurocognitive disorder — pathogenesis and prospects for treatment

The Synergistic Effects of HIV, Diabetes, and Aging on Cognition

Psychiatric symptom burden in older people living with HIV with and without cognitive impairment: the UCSF HIV over 60 cohort study

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