Comparing the unmatched count technique and direct self-report for sensitive health-risk behaviors in HIV+ adults

Researchers often rely on self-report measures to assess sensitive health-risk behaviors in HIV+ individuals, yet the accuracy of self-report has been questioned, particularly when inquiring about behaviors that may be embarrassing, risky, and/or taboo. We compared an anonymous reporting method—the Unmatched Count Technique (UCT)—to direct self-report in order to assess reporting differences for several health-risk behaviors related to medication adherence and sexual risk. Contrary to hypotheses, the UCT only produced a significantly higher estimated base rate for one sensitive behavior: reporting medication adherence to one\u27s physician, which may have been contextually-primed by our study design. Our results suggest that anonymous reporting methods may not increase disclosure compared to direct self-report when assessing several health-risk behaviors in HIV+ research volunteers. However, our results also suggest that contextual factors should be considered and investigated further, as they may influence perception of sensitive behavior

HIV Antiretroviral Medication Neuropenetrance and Neurocognitive Outcomes in HIV+ Adults: A Review of the Literature Examining the Central Nervous System Penetration Effectiveness Score

This literature review summarizes the existing research examining the CNS penetration effectiveness (CPE) score and neurocognitive outcomes (i.e., neuropsychological assessment and neurocognitive screening) in HIV+ individuals. Despite the effectiveness of Combined Antiretroviral Therapy (CART) in reducing mortality and morbidity in HIV and controlling viral replication, HIV often persists in the Central Nervous System (CNS), and rates of neurocognitive impairment remain higher than predicted in the post-CART era. The CPE score was developed to rank antiretroviral regimens on their ability to penetrate the CNS and potency in inhibiting the virus, and it has been examined in relation to neurocognitive functioning for over a decade. Based on the results of 23 studies, we conclude that CPE is not as strongly associated with neurocognitive outcomes as initially hypothesized, although higher CPE ARV regimens may be associated with modest, improved outcomes in global neurocognitive functioning, and to a lesser extent attention/working memory and learning/memory. Conclusions, however, are limited by the heterogeneity in study design and methods, and the lack of a more recent CPE metric update. It is recommended that future research in this area employ comprehensive, standardized neuropsychological test batteries and examine domain-level performance, and use the newer 2010 CPE metric, although an updated CPE ranking is urgently needed

Socioeconomic predictors of neuropsychological performance in an urban HIV+ cohort

This study explored socioeconomic (SES) factors and NP performance among a racially/ethnically diverse group of HIV+ adults. Since HIV disproportionately affects lower SES and racial/ethnic minority individuals and can cause NP impairment, the relationship between SES and NP performance may be particularly relevant to this population. The utility of three different SES measurements (applied to both childhood and adulthood SES estimates) was examined: Hollingshead Index of Social Prestige (ISP), Duncan Socioeconomic Index (SEI), and our own individualized socioeconomic estimate, based on years of education and income. Results indicated that adult SES estimates were more strongly linked to NP, particularly learning and memory, and that Hollingshead ISP was the most robust of the three SES predictors. Furthermore, SES mediated the relationship between NP performance and race/ethnicity. Overall, the results suggest that SES may be linked to NP performance. Therefore, this relationship should be examined further and expanded to other populations. More modern SES estimates should also be explored.

Cognitive Reserve in HIV: The Impact of Premorbid Verbal and Non-Verbal Performance on Longitudinal Neuropsychological Outcomes

Abstract not availabl

Increased neurocognitive intra-individual variability is associated with declines in medication adherence in HIV-infected adults.

OBJECTIVE: There is cross-sectional evidence that neurocognitive intra-individual variability (IIV), or dispersion, is elevated in human immunodeficiency virus (HIV) disease and is associated with declines in activities of daily living, including medication adherence. METHODS: This longitudinal study extends this literature by examining whether increased neurocognitive IIV in HIV-positive persons over time predicts declines in medication adherence above and beyond changes in mean level of performance over a 6-month observation. RESULTS: After controlling for drug use, declines in mean performance, and changes in depressive symptoms, results confirmed that increases in IIV were associated with overall poorer antiretroviral medication adherence. HIV-positive individuals with the greatest increases in dispersion demonstrated marked reductions in adherence by the third month that exceeded what was observed in less variable individuals. CONCLUSIONS: Our results indicate that increases in dispersion are associated with poorer declines in medication adherence in HIV disease, which may have implications for the early detection and remediation of suboptimal antiretroviral adherence

Quality of education predicts performance on the Wide Range Achievement Test-4th Edition Word Reading subtest.

The current study examined whether self-rated education quality predicts Wide Range Achievement Test-4th Edition (WRAT-4) Word Reading subtest and neurocognitive performance, and aimed to establish this subtest's construct validity as an educational quality measure. In a community-based adult sample (N = 106), we tested whether education quality both increased the prediction of Word Reading scores beyond demographic variables and predicted global neurocognitive functioning after adjusting for WRAT-4. As expected, race/ethnicity and education predicted WRAT-4 reading performance. Hierarchical regression revealed that when including education quality, the amount of WRAT-4's explained variance increased significantly, with race/ethnicity and both education quality and years as significant predictors. Finally, WRAT-4 scores, but not education quality, predicted neurocognitive performance. Results support WRAT-4 Word Reading as a valid proxy measure for education quality and a key predictor of neurocognitive performance. Future research should examine these findings in larger, more diverse samples to determine their robust nature

HIV-transmission-related risk behavior in HIV+ African American men: Exploring biological, psychological, cognitive, and social factors

ObjectivesTo identify factors associated with HIV-transmission-related risk behavior among HIV+ African American men.MethodWe examined biological, psychological, cognitive, and social factors and recent HIV-transmission-related risk behavior (i.e., needle sharing, unprotected sex, exchange sex) among a sample of HIV+ African American men.ResultsA binary logistic regression showed that individuals under age 50 (OR=4.2), with clinically-elevated masochism scores (OR=3.9) on the Millon Clinical Multiaxial Inventory-III (MCMI-III), current substance abuse/dependence (OR=2.6), and higher sensation-seeking (OR=1.3) were more likely to report recent risk behavior.ConclusionsReducing substance use, addressing self-defeating attitudes, and improving self-control may be avenues for future prevention and intervention research among HIV+ African American men engaging in HIV-transmission-related risk behavior

Increased neurocognitive intra-individual variability is associated with declines in medication adherence in HIV-infected adults.

There is cross-sectional evidence that neurocognitive intra-individual variability (IIV), or dispersion, is elevated in HIV disease and is associated with declines in activities of daily living, including medication adherence. This longitudinal study extends this literature by examining whether increased neurocognitive IIV in HIV+ persons over time predicts declines in medication adherence above and beyond changes in mean level of performance over a six-month observation. After controlling for drug use, declines in mean performance, and changes in depressive symptoms, results confirmed that increases in IIV were associated with overall poorer antiretroviral medication adherence. HIV+ individuals with the greatest increases in dispersion demonstrated marked reductions in adherence by the third month that exceed that observed in less variable individuals. Our results indicate that increases in dispersion are associated with poorer declines in medication adherence in HIV disease, which may have implications for the early detection and remediation of suboptimal antiretroviral adherence

Mild test anxiety influences neurocognitive performance among African Americans and European Americans: Identifying interfering and facilitating sources.

The current study examined ethnic/racial differences in test-related anxiety and its relationship to neurocognitive performance in a community sample of African American (n = 40) and European American (n = 36) adults. The authors hypothesized the following: (a) Test-anxiety related to negative performance evaluation would be associated with lower neurocognitive performance, whereas anxiety unrelated to negative evaluation would be associated with higher neurocognitive performance. (b) African American participants would report higher levels of anxiety about negative performance evaluation than European Americans. (c) European Americans would report higher levels of anxiety unrelated to negative performance evaluation. The first two hypotheses were supported: Ethnic/racial differences in test-taking anxiety emerged such that African Americans reported significantly higher levels of negative performance evaluation, which was associated with lower cognitive performance. The third hypothesis was not supported: African Americans and European Americans reported similar levels of test-anxiety unrelated to negative evaluation