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Real-world impact of neurocognitive deficits in acute and early HIV infection

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Abstract

The acute and early period of HIV-1 infection (AEH) is characterized by neuroinflammatory and immunopathogenic processes that can alter the integrity of neural systems and neurocognitive functions. However, the extent to which central nervous system changes in AEH confer increased risk of real-world functioning (RWF) problems is not known. In the present study, 34 individuals with AEH and 39 seronegative comparison participants completed standardized neuromedical, psychiatric, and neurocognitive research evaluations, alongside a comprehensive assessment of RWF that included cognitive symptoms in daily life, basic and instrumental activities of daily living, clinician-rated global functioning, and employment. Results showed that AEH was associated with a significantly increased risk of dependence in RWF, which was particularly elevated among AEH persons with global neurocognitive impairment (NCI). Among those with AEH, NCI (i.e., deficits in learning and information processing speed), mood disorders (i.e., Bipolar Disorder), and substance dependence (e.g., methamphetamine dependence) were all independently predictive of RWF dependence. Findings suggest that neurocognitively impaired individuals with AEH are at notably elevated risk of clinically significant challenges in normal daily functioning. Screening for neurocognitive, mood, and substance use disorders in AEH may facilitate identification of individuals at high risk of functional dependence who may benefit from psychological and medical strategies to manage their neuropsychiatric conditions.

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Acknowledgments

The Translational Methamphetamine AIDS Research Center (TMARC) group is affiliated with the University of California, San Diego (UCSD) and the Sanford-Burnham Medical Research Institute. The TMARC is comprised of: Director: Igor Grant, M.D.; Co-Directors: Ronald J. Ellis, M.D., Ph.D., Cristian Achim, M.D., Ph.D., and Scott Letendre, M.D.; Center Manager: Steven Paul Woods, Psy.D.; Aaron Carr (Assistant Center Manager); Clinical Assessment and Laboratory Core: Scott Letendre, M.D. (P.I.), Ronald J. Ellis, M.D., Ph.D., Rachel Schrier, Ph.D.; Neuropsychiatric Core: Robert K. Heaton, Ph.D. (P.I.), J. Hampton Atkinson, M.D., Mariana Cherner, Ph.D., Thomas Marcotte, Ph.D.; Neuroimaging Core: Gregory Brown, Ph.D. (P.I.), Terry Jernigan, Ph.D., Anders Dale, Ph.D., Thomas Liu, Ph.D., Miriam Scadeng, Ph.D., Christine Fennema-Notestine, Ph.D., Sarah L. Archibald, M.A.; Neurosciences and Animal Models Core: Cristian Achim, M.D., Ph.D., Eliezer Masliah, M.D., Stuart Lipton, M.D., Ph.D.; Participant Unit: J. Hampton Atkinson, M.D., Rodney von Jaeger, M.P.H. (Unit Manager); Data Management and Information Systems Unit: Anthony C. Gamst, Ph.D., Clint Cushman (Unit Manager); Statistics Unit: Ian Abramson, Ph.D. (P.I.), Florin Vaida, Ph.D., Reena Deutsch, Ph.D., Anya Umlauf, M.S.; Project 1: Arpi Minassian, Ph.D. (P.I.), William Perry, Ph.D., Mark Geyer, Ph.D., Brook Henry, Ph.D.; Project 2: Amanda B. Grethe, Ph.D. (P.I.), Martin Paulus, M.D., Ronald J. Ellis, M.D., Ph.D.; Project 3: Sheldon Morris, M.D., M.P.H. (P.I.), David M. Smith, M.D., M.A.S., Igor Grant, M.D.; Project 4: Svetlana Semenova, Ph.D. (P.I.), Athina Markou, Ph.D.; Project 5: Marcus Kaul, Ph.D. (P.I.).The authors report no conflicts of interest. This research was supported by National Institutes of Health grants P50-DA026306, P30-MH62512, T32-DA31098, DA-034510, F31-DA035708, AI-090970, AI-100665, AI-080353, MH-097520, DA-034978, MH-83552, MH-62512, AI-74621, AI-43638, AI-36214, TW-008908, AI-69432, AI-096113, and AI-47745. This work was additionally supported by the Department of Veterans Affairs and grants awarded from the International AIDS Vaccine Initiative (IAVI), the National Science Foundation DMS0714991, and the James B. Pendleton Charitable Trust. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government.

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Authors and Affiliations

  1. Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego, CA, USA

    Katie L. Doyle & Kaitlin Blackstone

  2. Department of Psychiatry, University of California, 220 Dickinson St., Suite B, San Diego, CA, 92103, USA

    Erin E. Morgan, Jennifer E. Iudicello, David J. Moore, Igor Grant & Steven Paul Woods

  3. Department of Medicine, University of California, San Diego, CA, USA

    Sheldon Morris, Davey M. Smith, Susan Little & Scott L. Letendre

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  1. Katie L. Doyle
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  2. Erin E. Morgan
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  6. Jennifer E. Iudicello
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The Translational Methamphetamine AIDS Research Center (TMARC) Group

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Correspondence to Steven Paul Woods.

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Doyle, K.L., Morgan, E.E., Morris, S. et al. Real-world impact of neurocognitive deficits in acute and early HIV infection. J. Neurovirol. 19, 565–573 (2013). https://doi.org/10.1007/s13365-013-0218-2

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  • DOI: https://doi.org/10.1007/s13365-013-0218-2

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