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Real-World Impact of HIV-Associated Neurocognitive Impairment

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Changes in the Brain

Abstract

While major advances in HIV management over the last 20 years have resulted in drastically improved health and survival outcomes, neurocognitive dysfunction remains a major health burden. HIV-associated neurocognitive disorders primarily affect frontostriatal neural systems disproportionally disrupting cognitive flexibility, working memory, generativity, and novel learning and recall, and increased risk for a host of downstream adverse real-world outcomes. Our chapter reviews the current literature on the nature and impact of HIV-associated neurocognitive impairment on everyday functioning, including both subjective and objective indicators of global independence on activities of daily living, antiretroviral adherence, employment, driving, HIV transmission risk behaviors, and health-related quality of life. We propose a multifactorial model of everyday functioning, with a specific focus on the neurocognitive contribution, to help guide our thinking of how HIV-associated central nervous system dysfunction may manifest in the real world. A considerable body of literature supports the unique role of neurocognitive impairment, especially executive dysfunction and deficits in episodic memory, as a risk factor for real world problems among individuals with HIV. These data converge to further establish the relationship between HIV-associated neurocognitive dysfunction and everyday abilities, and point to the need for novel theoretically and empirically based treatment tools to support cognitive health and successful everyday functioning in the ever-changing landscape of HIV disease.

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Acknowledgments

The preparation of this chapter was supported by F31-DA034510, F31-DA035708, P30-MH062512, P50-DA026306, R01-MH073419, R21-MH098607, and T32-DA031098. 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 US Government.

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  1. Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, 92103, USA

    Kaitlin Blackstone Casaletto Ph.D. & Erica Weber Ph.D.

  2. Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA

    Kaitlin Blackstone Casaletto Ph.D.

  3. Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ, 07052, USA

    Erica Weber Ph.D.

  4. Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, 220 Dickinson Street, Suite B, San Diego, CA, 92103, USA

    Jennifer E. Iudicello Ph.D. & Steven Paul Woods Psy.D.

  5. Department of Psychology, University of Houston, 126 Heyne Building, Suite 204, Houston, TX, 77004-5022, USA

    Steven Paul Woods Psy.D.

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  1. Kaitlin Blackstone Casaletto Ph.D.
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  3. Jennifer E. Iudicello Ph.D.
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Correspondence to Steven Paul Woods Psy.D. .

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    Nancy D. Chiaravalloti

  2. Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA

    Yael Goverover

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Casaletto, K.B., Weber, E., Iudicello, J.E., Woods, S.P. (2017). Real-World Impact of HIV-Associated Neurocognitive Impairment. In: Chiaravalloti, N., Goverover, Y. (eds) Changes in the Brain. Springer, New York, NY. https://doi.org/10.1007/978-0-387-98188-8_10

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