The Intersection of Cognitive Ability and HIV: A Review of the State of the Nursing Science

Abstract

Neurocognitive problems have been endemic to the HIV epidemic since its beginning. Four decades later, these problems persist, but currently, they are attributed to HIV-induced inflammation, the long-term effects of combination antiretroviral therapy, lifestyle (i.e., physical activity, drug use), psychiatric, and age-associated comorbidities (i.e., heart disease, hypertension). In many cases, persons living with HIV (PLWH) may develop cognitive problems as a function of accelerated or accentuated normal aging and lifestyle rather than HIV itself. Nonetheless, such cognitive impairments can interfere with HIV care, including medication adherence and attending clinic appointments. With more than half of PLWH 50 years and older, and 30%-50% of all PLWH meeting the criteria for HIV-associated neurocognitive disorder, those aging with HIV may be more vulnerable to developing cognitive problems. This state of the science article provides an overview of current issues and provides implications for practice, policy, and research to promote successful cognitive functioning in PLWH.

Driving habits, cognition, and health-related quality of life in middle-aged and older adults with HIV

“…Among other factors, lack of licensure may be attributed to PLWH's socioeconomic constraints (Vance et al, 2015) given that most of our sample had annual household incomes of less than $20,000, an assumption supported by the significant association found between education and income with licensure status, as well as several other driving variables. This association resonates with the complexities (e.g., poverty, limited social resources) faced by PLWH that may be especially exacerbated among African Americans in the Deep South where this study was conducted (Quinn et al, 2017;Reif et al, 2017); in fact, such health disparities that may comprise brain health may account for the higher prevalence (58%) of cognitive impairment observed in this study, compared to the normal range observed in the literature between 30 and 50% of those with HIV (Waldrop et al, 2021). Other demographic associations with valid licensure included white race and older age.…”

Parallels Between NeuroHIV and NeuroCOVID-19: Considerations for a Post-COVID-19 Era

“…Still, the prevalence of mild-to-moderate cognitive impairments (e.g., HIV-associated neurocognitive disorder [HAND]) remains high, affecting between 30% to 50% of PLWH. HAND is defined as a collection of cognitive symptoms whereby an individual scores 1 or more SD s below the norm-based (age, education, sex, and race) mean on cognitive performance tests in two or more cognitive domains (e.g., executive functioning, verbal memory, and psychomotor functioning; Waldrop et al, 2021 ). HAND can emerge from a variety of synergistic factors, including age-related brain changes, comorbid physical conditions, psychiatric conditions, and social factors (e.g., stigma and social withdrawal).…”

“…Second, the pandemic has been a highly stressful time, with many individuals concerned about becoming ill, finances, caregiving for others, and experiencing new roles. As with primary inflammation, such stress can increase cortisol production through overactivation of the HPA axis, resulting in both systemic and neuroinflammation ( Cody & Vance, 2016 ; Waldrop et al, 2021 ).…”

“…For those infected with SARS-CoV-2, the infection itself and certain treatments (e.g., ventilation) may leave residual or long-term effects for months or even years. In either case, for many PLWH who are already cognitively vulnerable, assessment and monitoring of cognitive function should be considered during routine clinic visits ( Waldrop et al, 2021 ). From a clinical and research perspective, the long-term effects of SARS-CoV-2, in both preventive measures and long-term disease sequelae, remain unknown.…”

“…Second, from both a clinical and a research perspective, strategies are needed to protect brain health and/or remediate for cognitive loss (for a review of such strategies, see Waldrop et al, 2021 ). Several strategies are already being considered, but most focus around the concept of brain health literacy.…”