Empiric neurocognitive performance profile discovery and interpretation in HIV infection

Gomez, Daniela; Power, Christopher; Gill, M John; Koenig, Noshin; Vega, Roberto; Fujiwara, Esther

doi:10.1007/s13365-018-0685-6

Cited by 14 publications

(16 citation statements)

References 62 publications

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“…Alcohol use is also a dynamic behaviour, and change in the pattern of use due to intervention may not have been present long enough to lead to enduring change in viral load and/or CD4 count. Further, CD4 count measured at baseline may not be a good predictor of change and CD4 nadir maybe a better predictor of future CD4 change [59, 60]. The adherence measures in the studies reviewed were self-report or pill count, but these have also been shown to be unreliable, with antiretroviral drug levels being a better and more reliable assessment of adherence.…”

Section: Discussionmentioning

confidence: 99%

Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review

et al. 2019

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BackgroundAlcohol use disorders (AUDs) in people living with HIV/AIDS (PLWH) are a significant impediment to achieving virological control. HIV non-suppression in PLWH with AUDs is mainly attributable to sub-optimal antiretroviral therapy adherence. Sub-optimal adherence makes control of the epidemic elusive, considering that effective antiretroviral treatment and viral suppression are the two key pillars in reducing new infections. Psychological interventions have been proposed as effective treatments for the management of AUDs in PLWH. Evidence for their effectiveness has been inconsistent, with two reviews (2010 and 2013) concluding a lack of effectiveness. However, a 2017 review that examined multiple HIV prevention and treatment outcomes suggested that behavioural interventions were effective in reducing alcohol use. Since then, several studies have been published necessitating a re-examination of this evidence. This review provides an updated synthesis of the effectiveness of psychological interventions for AUDs in PLWH.MethodsA search was conducted in the following databases: PubMed, Cochrane Central Register of Trials (CENTRAL), MEDLINE (Ovid), EMBASE, PsychInfo (Ovid) and Clinical trials.gov (clinicaltrials.gov) for eligible studies until August 2018 for psychotherapy and psychosocial interventions for PLWH with AUDs. Two reviewers independently screened titles, abstracts and full texts to select studies that met the inclusion criteria. Two reviewers independently performed data extraction with any differences resolved through discussion. Risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool, and the concordance between the first and second reviewers was 0.63 and between the first and third reviewers 0.71. Inclusion criteria were randomised controlled trials using psychological interventions in people aged 16 and above, with comparisons being usual care, enhanced usual care, other active treatments or waitlist controls.ResultsA total of 21 studies (6954 participants) were included in this review. Studies had diverse populations including men alone, men and women and men who had sex with men (MSM). Use of motivational interviewing alone or blended with cognitive behavioural therapy (CBT) and technology/computer-assisted platforms were common as individual-level interventions, while a few studies investigated group motivational interviewing or CBT. Alcohol use outcomes were all self-report and included assessment of the quantity and the frequency of alcohol use. Measured secondary outcomes included viral load, CD4 count or other self-reported outcomes. There was a lack of evidence for significant intervention effects in the included studies. Isolated effects of motivational interviewing, cognitive behavioural therapy and group therapy were noted. However for some of the studies that found significant effects, the effect sizes were small and not sustained over time. Owing to the variation in outcome measures employed across studies, no meta-analysis could be carried out....

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Section: Discussionmentioning

confidence: 99%

Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review

et al. 2019

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“…Although executive function and memory deficits are most common in PWH in the post-ART era, the characterization of cognitive impairment in HIV is highly variable with deficits observed in a range of cognitive domains (3). Previous studies using statistical clustering techniques have identified differing profiles of cognitive function among PWH with some profiles resembling global impairment across domains while other profiles resemble more domain-specific impairment, particularly in the domains of episodic memory and executive function (4)(5)(6)(7). Similarly, there is also substantial variability in the risk factors associated with cognitive deficits among PWH that range from biological (e.g., CD4 + T-cell count, HIV viral load, comorbid health conditions), demographic (e.g., age, sex, race/ethnicity) to psychosocial factors (e.g., low education, depression, substance use/dependence).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, we determined how sociodemographic (e.g., age, education, race/ethnicity), clinical (e.g., functional status, depression, substance use disorders) and biological (e.g., measures of HIV disease severity, ART use, cardiovascular comorbid conditions, Hepatitis C co-infection) factors related to cognitive profiles within women and men. Based on previous studies among PWH (4)(5)(6), we hypothesized that the machine learning approach would identify distinct subgroups of individuals with normal cognitive function, global cognitive impairment, and domainspecific cognitive impairment. We further hypothesized that groups with domain-specific cognitive impairment would differ by sex, with WWH showing more consistent memory and processing speed impairment than MWH.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in the Patterns and Predictors of Cognitive Function in HIV

et al. 2020

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Despite advancements in antiretroviral therapy, mild cognitive deficits persist in nearly half of people with HIV (PWH). The profile of impairment in HIV is highly variable with deficits observed in a range of cognitive domains. Despite evidence of greater cognitive impairment among women with HIV (WWH) vs. men with HIV (MWH), it is unclear how MWH and WWH differ in the type of cognitive impairment and in risk factors associated with cognitive impairment profiles. In a large and well-characterized sample of PWH, we used machine learning to identify profiles of cognitive functioning and their associated factors overall and within sex. Participants included 1,666 PWH (201 WWH; 1,465 MMH) from the HIV Neurobehavioral Research Program who completed a neuropsychological test battery at their baseline visits. Using demographically-adjusted T-scores from 13 test outcomes assessing motor skills, executive functioning, attention/working memory, episodic learning and memory, verbal fluency, and processing speed, we used Kohonen self-organizing maps to identify patterns of high-dimensional data by mapping participants to similar nodes based on T-scores (MCLUST R package). Random forest models were used to determine how sociodemographic (e.g., age, education), clinical (e.g., depressive symptoms, substance use disorder), and biological (e.g., HIV disease characteristics) factors differentially related to membership within a cognitive profile. All analyses were repeated within sex. Three cognitive profiles were identified overall and within each sex. Overall and within MWH, there were unimpaired and global weakness profiles. The third profile in the total sample demonstrated relatively weak auditory attention whereas in MWH showed relative strengths in attention and processing speed. Conversely, there was no unimpaired profile among WWH. Rather, WWH demonstrated separate profiles reflecting weakness in motor skills, a relative weakness in learning and delayed recall, and global weaknesses with spared recognition memory. Despite different cognitive profiles by sex, the most discriminative factors were similar between men and women and included reading level (cognitive reserve), current and nadir CD4 count, plasma HIV viral load, duration of HIV disease, age, depressive symptoms, and race/ethnicity. Findings fill a knowledge gap concerning sex differences in cognitive impairment in PWH and inform personalized risk reduction and therapeutic strategies.

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“…CI has been linked to incomplete HIV suppression in the CNS despite ART (Bingham et al, 2011;Tamarit Mdel et al, 2012;Chen et al, 2014;Zayyad and Spudich, 2015;Saylor et al, 2016), compartmentalization of HIV RNA (Ritola et al, 2005), CNS escape (Joseph et al, 2018), viral rebound in the CSF (Gianella et al, 2016), viral persistence in peripheral tissues (Chun et al, 2008(Chun et al, , 2015Fletcher et al, 2014;Martinez-Picado and Deeks, 2016), and genetic factors leading to a persistent HIV CNS reservoir (Anuurad et al, 2009;Mavigner et al, 2009;Joska et al, 2011). Despite the heterogeneity of these mechanisms of viral persistence, immune activation and inflammation arise as a common thread that both promote and result from the CNS viral reservoir (Brouillette et al, 2016;Rubin et al, 2017;Gomez et al, 2018). However, the neuroinflammatory processes that promote CI in the context of HIV are not completely understood.…”

Section: Introductionmentioning

confidence: 99%

Early Inflammatory Signatures Predict Subsequent Cognition in Long-Term Virally Suppressed Women With HIV

Rubin

Norris

et al. 2020

Front. Integr. Neurosci.

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Immune, Cognition, and HIV associations were significant in HIV+VS than HIV− women. Leukocyte influx into brain was a major contributor to cognitive function in HIV+VS women, while T cell exhaustion, inflammatory response indicative of depressive/psychiatric disorders, microglial activity, and cytokine signaling predicted both global and domain-specific performance for HIV− women. Our findings suggest that immune signatures may be useful diagnostic, prognostic, and immunotherapeutic targets predictive of subsequent cognitive performance. Importantly, they also provide insight into common and distinct inflammatory mechanisms underlying cognition in HIV− and HIV+VS women.

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Empiric neurocognitive performance profile discovery and interpretation in HIV infection

Cited by 14 publications

References 62 publications

Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review

Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review

Sex Differences in the Patterns and Predictors of Cognitive Function in HIV

Early Inflammatory Signatures Predict Subsequent Cognition in Long-Term Virally Suppressed Women With HIV

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