Neurocognitive Impairment and HIV Risk Factors: A Reciprocal Relationship

Abstract

Cognitive impairment among populations at risk for HIV poses a significant barrier to managing risk behaviors. The impact of HIV and several cofactors, including substance abuse and mental illness, on cognitive function is discussed in the context of HIV risk behaviors, medication adherence, and risk-reduction interventions. Literature suggests that cognitive impairment is intertwined in a close, reciprocal relationship with both risk behaviors and medication adherence. Not only do increased risk behaviors and suboptimal adherence exacerbate cognitive impairment, but cognitive impairment also reduces the effectiveness of interventions aimed at optimizing medication adherence and reducing risk. In order to be effective, risk-reduction interventions must therefore take into account the impact of cognitive impairment on learning and behavior.

Prevalence of Adult Attention Deficit Hyperactivity Disorder and its Correlates among Recently Diagnosed Young Adult Males with HIV

“…As per existing literature, HIV associated neurocognitive deficits increase the risk of non-adherence in HIV. Neurocognitive deficits in HIV may arise due to the disease process itself, as a result of co morbid substance use, associated psychiatric illnesses such as bipolar disorders, schizophrenia and developmental disorders such as ADHD and conduct disorder [18]. Cognitive deficits in ADHD being potentially treatable, may offer a new strategy for enhancing treatment adherence in HIV.…”

HIV-Related Neurocognitive Disorders and Drugs of Abuse: Mired in Confound, Surrounded by Risk

“…In general, individuals receiving methadone maintenance have been found to have impairments in attention, information processing, visual and verbal memory, and problem solving compared with non-opioid-using control groups [79]. HIV infection appears to exacerbate the problem.…”

“…Methamphetamine is highly neurotoxic, resulting in damage to the axon terminals of dopaminergic neurons and depleting both dopamine and norepinephrine, and even leading to a Parkinsonian-like choreatic syndrome in some individuals [79]. HIV infection and methamphetamine use appear to have a synergistic effect, and multiple investigators have documented increased neurocognitive impairment in HIVpositive methamphetamine users as compared with control groups.…”

Dilemma of concepts and strategies for the prevention of spread of HIV in relation to human behavior, law and human rights

“…(7) Furthermore, the influence of neurocognitive disorders due to the HIV infection itself [HIV associated neurocognitive disorder (HAND)] and opportunistic infections of the brain, e.g., toxoplasma gondii, cytomegalovirus which may contribute too, have yet to be taken into account (Lawrence and Major, 2002;Anand et al, 2010). The sequels of neurological impairments include more HIV-risk behavior and poorer cART adherence.…”