Neuropsychological test performance before and after HIV-1 seroconversion: the Multicenter AIDS Cohort Study

Abstract

Objectives To compare neuropsychological test performance before and after HIV-1 seroconversion in order to identify possible acute changes in psychomotor speed, memory, attention, and concentration secondary to seroconversion. Design Mixed effects models to examine longitudinal neuropsychological test data. Methods We conducted a nested cohort study of 362 male HIV-1 seroconverters enrolled in the Multicenter AIDS Cohort Study. We used linear mixed models with random subject effects to compare repeated neuropsychological test outcomes from 5 years before seroconversion to 2 years after seroconversion on the Trail Making Test (Parts A & B), Symbol-Digit Test, Grooved Pegboard (dominant and non-dominant hands), Stroop Color-Interference Test, Rey Auditory Verbal Learning Test, and the CalCAP Reaction Time Test. Results We found no significant changes in the time-dependent score after seroconversion for the majority of neuropsychological tests used in the Multicenter AIDS Cohort Study. There was a significant change in time trend after seroconversion on part B of the Trail Making Test (p=0.042) but the difference only represented a 2% decrease in performance. We found the following characteristics to be associated with worse neuropsychological test performance: lower education levels, history of depression, older age, and no previous neurocognitive testing (p<.05). Conclusion Our results suggest that despite a 50% decrease in CD4 cell count immediately following infection, HIV-1 does not appear to have a measurable effect on psychomotor or complex cognitive processing for up to 2 years following infection, using this set of neurocognitive measures.

HIV-associated neurocognitive disorder — pathogenesis and prospects for treatment

“…The increased risk of conversion to symptomatic dementia for individuals with ANI could reflect the finding that some individuals have very early involvement of the brain after HIV infection. For example, structural brain changes can sometimes be identified by neuroimaging within 100 days of primary infection, even in the absence of symptomatic involvement 17,18 . However, the term ANI should be reserved for research studies, as its use in clinical settings remains controversial.…”

Neurobehavioral Disturbances During Acute and Early HIV Infection

“…Moreover, the severity of disinhibition did not change notably after seroconversion. This pattern suggests that disinhibition may precede HIV infection and remain stable over the course of the disease (see Vo et al, 2013). In fact, disinhibition, which is prevalent in at-risk populations such as individuals with substance use disorders and bipolar disorder, may be a risk factor for acquiring and transmitting HIV (Kalichman, 2006).…”

“…For example, apathy affects approximately 40% of chronically infected persons and is independently associated with a decline in independence in activities of daily living (Kamat et al, 2012), with medication nonadherence (Barclay et al, 2007; Rabkin et al, 2000), and with lower health-related quality of life (Tate et al, 2003). Indeed, rates of neurobehavioral disturbances such as disinhibition may be elevated before seroconversion and may encourage risk behaviors that can further spread HIV (Atkinson et al, 2009; Vo et al, 2013). …”

Relationship between HIV stage and psychomotor speed neurocognitive score at a Kenyan sub-county hospital

“…About 5.1% of the participants were on antiretroviral therapy which could also have had a protective effect and therefore affected the results obtained. 33 …”