Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe

Background HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. It typically affects memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning cognitive domains. NCI can affect adherence to antiretroviral therapy (ART), employability, driving ability and activities of daily living. NCI is not routinely screened for in Zimbabwe, and the burden is not known in this setting. The objectives of this study were: 1) To determine NCI prevalence using a comprehensive neuropsychological battery at two primary health care clinics in Harare; 2) To assess the pattern of cognitive impairment across cognitive domains using a gold standard neuropsychological (NP) battery in HIV-positive patients compared to HIV-negative controls. Methods Inclusion criteria: 18 years or older; minimum 7 years education; no neurological or psychiatric disorders. HIV-positive participants were on ART for ≥3 months; HIV-negative participants had a confirmed HIV negative status in the past month. A comprehensive NP battery, functional assessments, demographic and medical history questionnaires were administered. The NP battery consisted of tests assessing memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning. Results Two-hundred-and-thirty-one participants were recruited. Of those, 155 were HIV-positive (Female = 70%, Age M = 37.8; SD 11.2) and 76 HIV-negative (Female = 63%, Age M = 31.2; SD 9.9). HIV-positive participants were on ART for an average of 6 years. NCI was present in 49.7% HIV positive participants. Compared to HIV-negative participants, the HIV-positive group had significantly poorer scores in 5 out of 7 cognitive domains. A good level of education is negatively correlated with NCI. Conclusions NCI prevalence in HIV-positive population Zimbabwe is consistent with global estimates. NCI persists in adults who are on ART. Routine assessment of NCI in adults attending primary care clinics using this adapted battery is therefore important so that they are identified early and are provided the necessary interventions

Assessment of neurocognitive deficits in people living with HIV in Sub Saharan Africa: A systematic review.

OBJECTIVE: People living with HIV (PLWH) are at risk for HIV-Associated Neurocognitive Disorders (HAND)/Neurocognitive Impairment (NCI). HIV prevalence in Sub-Saharan Africa (SSA) is high, but neuropsychological screening and testing for NCI among HIV-infected individuals is not done frequently. This systematic review aims to establish how NCI among HIV-infected individuals is being assessed in SSA, if and how the tests are adapted, if norms exist and identify personnel who administer them. METHOD: We searched PubMed, Medline, EBSCO, PsycINFO, and Web of Science. Two reviewers screened the articles for inclusion and risk of bias. We included studies from SSA with a comprehensive neuropsychological assessment battery. RESULTS: We retrieved 212 articles and 23 articles met inclusion criteria. The most commonly used tests were the Color Trails Test 1, Color Trails Test 2, and the WAIS III Digit Symbol Test. Some tests were translated into French (Cameroon), Luganda (Uganda), Chichewa (Malawi), isiXhosa (South Africa), and Afrikaans (South Africa). Some verbal learning tests were adapted to reflect culturally appropriate language. Test administrators were either non-specialized personnel supervised by clinical neuropsychologists or clinical psychologists. CONCLUSION: Overall, the tests used are similar to the tests being used globally to assess NCI among HIV-infected individuals and there is a general consistency across countries. However, there is generally a lack of norms for the tests and the process of adaptation is not always well described. Future research should establish whether these tests measure neuropsychological constructs as successfully as they do in western populations where the tests were developed

Individual and Contextual Factors of Sexual Risk Behavior in Youth Perinatally Infected with HIV

Abstract This study prospectively examines the effects of maternal and child HIV infection on youth penetrative and unprotected penetrative sex, as well as the role of internal contextual, external contextual, social and self-regulatory factors in influencing the sexual behaviors of HIV?infected (PHIV+), HIV?affected (uninfected with an HIV+ caregiver), and HIV unaffected (uninfected with an HIV? caregiver) youth over time. Data (N=420) were drawn from two longitudinal studies focused on the effects of pediatric or maternal HIV on youth (51% female; 39% PHIV+) and their caregivers (92% female; 46% HIV+). PHIV+ youth were significantly less likely to engage in penetrative sex than HIV? youth at follow-up, after adjusting for contextual, social, and self-regulatory factors. Other individual- and contextual-level factors such as youth alcohol and marijuana use, residing with a biological parent, caregiver employment, caregiver marijuana use, and youth self-concept were also associated with penetrative sex. Youth who used alcohol were significantly more likely to engage in unprotected penetrative sex. Data suggest that, despite contextual, social, and self-regulatory risk factors, PHIV+ youth are less likely to engage in sexual behavior compared to HIV? youth from similar environments. Further research is required to understand delays in sexual activity in PHIV+ youth and also to understand potential factors that promote resiliency, particularly as they age into older adolescence and young adulthood.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98470/1/apc%2E2012%2E0005.pd

Cultural and neuropsychological predictors of medication adherence

HIV infection among the Hispanic community is disproportionate to the overall population of the United States. Hispanics account for 13% of the U.S. population, yet they account for 20% of reported AIDS cases in the U.S. Numerous studies have identified the detrimental neurocognitive sequela and functional impact of HIV infection, and research has shown that ethnic minorities are less likely to adhere to medical protocols. Highly active antiretroviral therapy (HAART) for HIV/AIDS has helped to inhibit the detrimental neurocognitive effects of HIV\u27s involvement in the central nervous system. However, in order to benefit from HAART, individuals must be near perfect in their compliance. Studies have shown that individuals with neuropsychological (NP) impairment are less likely to adhere to their medication regimens. However, these studies have examined mostly African American populations, with no emphasis on cultural differences. With disproportionate rates of HIV infection among Hispanics, the high rate of new infections among Hispanics, and the risk of not adhering to medical protocols, this group is at particularly high risk for neurocognitive impairment and impaired functioning in everyday activities. The present study examined the role NP and cultural factors play in HAART adherence in a sample of HIV+ Hispanic and non-Hispanic white adults. Methods. Forty-two HIV+ participants (28 Hispanic and 14 non-Hispanic white) were recruited. All participants underwent neuromedical and psychiatric screening, as well as s comprehensive NP evaluations. In addition, participants were administered a 30-day self-report questionnaire of HAART adherence. Hispanic participants also completed an acculturation measure. Results. Mean adherence rate for Hispanics was significantly lower than 95% and the non-Hispanic white mean adherence rate. Global NP functioning was positively correlated with adherence rate among all participants, as were the NP domains of memory and motor functioning. No association between acculturation and adherence was found. Conclusion. The current indicated that HIV+ Hispanics have poorer adherence compared to non-Hispanic whites and significantly lower adherence than the recommended 95%. Additionally, NP functioning is also related to adherence among HIV+ Hispanics and non-Hispanic whites

Multidimensional effects of acculturation on English-language neuropsychological test performance among HIV+ Caribbean Latinas/os

Acculturation has been linked to neuropsychological performance in several ethnic groups. However, research among Latina/o samples has examined primarily Mexicans/Mexican Americans and has not examined Latina/o clinical populations of Caribbean descent. This study examined associations between a multidimensional acculturation measure and neuropsychological performance among 82 HIV+ Caribbean Latina/o adults. Multivariate results showed that US acculturation significantly predicted 11–14% of the variance in global neuropsychological functioning, verbal fluency, and processing speed, whereas Latina/o acculturation predicted 6-8% of the variance in motor and executive function (trend level associations). Both linguistic and nonlinguistic cultural factors had distinct effects on neuropsychological performance

HIV-related enacted stigma and increase frequency of depressive symptoms among Thai and Cambodian adolescents and young adults with perinatal HIV

HIV-related enacted stigma and social problems may increase risk for depression and/or behavioral problems among adolescents and young adults with perinatal HIV(AYA-PHIV), yet few studies have explored stigma in AYA-PHIV residing in low-to-middle income regions, including Southeast Asia. We assessed HIV-related enacted stigma and social problems in AYA-PHIV who participated in the RESILIENCE study (clinicaltrials.gov identification: U19AI53741) in Thailand and Cambodia using specific questions during structured in-person interviews. Depression was measured by the Child Depression Inventory for children <15 years, or the Center for Epidemiologic Studies Depression Scales for youth ≥15 years); behavioral problems were measured by the Child Behavior Checklist (CBCL-caregiver report). Among 195 AYA-PHIV (median age 16.9 years), 25.6% reported a lifetime experience of enacted stigma, while 10.8% experienced social problems due to HIV infection. The frequency of depressive symptoms was nearly two-fold higher among AYA-PHIV with compared to those without HIV-related enacted stigma (34.7% vs. 16.0%, p = 0.005). Caregiver-reported behavioral problems were detected in 14.6% of all AYA-PHIV, with no differences between those with and without HIV-related enacted stigma. Low household income and caregiver mental health problems were independent risk factors for depressive symptoms; HIV-related enacted stigma was also associated with increased risk, warranting targeted services to support AYA-PHIV