AIDS and Behavior

, Volume 15, Issue 8, pp 1879–1887 | Cite as

Depression and Neurocognitive Performance in Portuguese Patients Infected with HIV

  • Miguel Bragança
  • António Palha
Original Paper


This study focused on neurocognitive disorders associated with HIV infection, characterizes the most affected neuropsychological domains and their potential as factors related with depression. 130 HIV-positive individuals with CD4 >200 cells/mm3, undetectable viral load, treated with HAART and with all kinds of risk behaviors were included. A structured interview composed by seven sections was used and relevant clinical and laboratory data was assessed. For the neuropsychological and depression assessment the HIV Neurobehavioral Research Center (HNRC) Battery and Hamilton Rating Scale for Depression (HAM-D) were chosen. Univariate nonparametric statistics and multivariate regression model were performed. Among 34% of depressed subjects, 20.7% had attempted suicide, 45.4% were under psychiatric medication and only 19% had no diagnostic criteria for HIV Associated Neurocognitive Disorders (HAND). The effect of depression on cognitive function revealed a significant deterioration in five of the eight measures. In the multivariate analysis, five variables significantly determined depression: sex, social class, antidepressant medication, history of suicide attempt and Dexterity and motor speed (neuropsychological test battery). Despite good patient adherence to treatment (HAART and antidepressive) and good immune status, the prevalence of HAND and depression are high and suggest a significant relation between severity of depression and cognitive functioning.


Cognition Depressive disorder HIV/AIDS Neuropsychological functioning Psychiatry 


Este estudio se centra en los trastornos neurocognitivos asociados a la infección por el VIH, caracteriza los dominios neuropsicológicos más afectados y su potencial relación con la depresión. Fueron incluidos en el estudio 130 individuos VIH-positivos con CD4 >200 células/mm3, carga viral indetectable, medicados con HAART abarcando todos los comportamientos de riesgo. Fue utilizada una entrevista estructurada compuesta por siete secciones y se evaluaron los datos clínicos y de laboratorio. Para la evaluación neuropsicológica y la depresión fueron elegidas la batería de lo HNRC (HIV Neurobehavioral Research Center) y la Escala de Hamilton para Depresión (HAM-D). Se utilizaran estadísticas univariantes no paramétricas y el modelo de regresión multivariante. Entre el 34% de los sujetos deprimidos, el 20,7% había intentado suicidarse, el 45,4% hacían medicación psiquiátrica, y sólo el 19% carecía de criterios para el diagnóstico trastornos neurocognitivos asociado al VIH (HAND). El efecto de la depresión sobre la función cognitiva revela un deterioro significativo en cinco de las ocho medidas. En el análisis multivariado, cinco variables se asocian significativamente con la depresión: el sexo, la clase social, los medicamentos antidepresivos, la historia de intentos de suicidio y la destreza y velocidad motora (batería neuropsicológica). A pesar de buena adherencia de los pacientes al tratamiento (HAART y antidepresivos) y del buen estado inmunológico, la prevalencia de HAND y depresión son altas y sugieren una relación significativa entre la gravedad de la depresión y el funcionamiento cognitivo.

Palabras clave

Cognición Trastorno depresivo VIH / SIDA Funcionamiento neuropsicológico Psiquiatría 



The authors would like to thank the Investigation Center of Hospital S. João, Oporto and Glaxo SmithKleine Foundation for Life Sciences, that supported this research.


  1. 1.
    Grant I. Neurocognitive disturbances in HIV. Int Rev Psychiatry. 2008;20:33–47.PubMedCrossRefGoogle Scholar
  2. 2.
    Cherner M, Masliah E, Ellis RJ, Marcotte TD, Moore DJ, Grant I, Heaton RK, The HNRC Group. Neurocognitive dysfunction during life predicts postmortem findings of HIV encephalitis. Neurology. 2002;59:1563–7.PubMedGoogle Scholar
  3. 3.
    Woods SP, Moore DJ, Weber E, Grant I. Cognitive neuropsychology of HIV-associated neurocognitive disorders. Neuropsychol Rev. 2009;19(2):152–68.PubMedCrossRefGoogle Scholar
  4. 4.
    Reger M, Welsh R, Razani J, Martin DJ, Boone KB. A meta-analysis of the neuropsychological sequelae of HIV infection. J Int Neuropsychol Soc. 2002;8:410–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Gorman AA, Foley JM, Ettenhofer ML, Hinkin CH, van Gorp WG. Functional consequences of HIV-associated neuropsychological impairment. Neuropsychol Rev. 2009;19(2):186–203.PubMedCrossRefGoogle Scholar
  6. 6.
    Hinkin CH, Castellon SA, Durvasula RS, Hardy DJ, Lam MN, Mason KI, et al. Medication adherence among HIV+ adults: effects of cognitive dysfunction and regimen complexity. Neurology. 2002;59:1944–50.PubMedGoogle Scholar
  7. 7.
    Sacktor N, McDermott MP, Marder K, Schifitto G, Selnes OA, McArthur JC, et al. HIV-associated cognitive impairment before and after the advent of combination therapy. J Neurovirol. 2002;8(2):136–42.PubMedCrossRefGoogle Scholar
  8. 8.
    Lezak MD, Howieson DB, Loring DW, Hannay J, Fischer JS. Neuropsychological assessment. 4th ed. New York: Oxford University Press; 2004.Google Scholar
  9. 9.
    Morrison MF, Petitto JM, Have TT, Gettes DR, Chiappini MS, Weber AL, et al. Depressive and anxiety disorders in women with HIV infection. Am J Psychiatry. 2002;159(5):789–96.PubMedCrossRefGoogle Scholar
  10. 10.
    Benton TD. Depression and HIV/AIDS. Curr Psychiatry Rep. 2008;10(3):280–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Stolar A, Fernandez F, Catalano G, Hakala S, Bright R. Mood disorders and psychosis in HIV-1. In: Citron K, Brouillette MJ, Beckett A, editors. HIV and psychiatry: a training and resource manual. 2nd ed. Cambridge: Cambridge University Press; 2005.Google Scholar
  12. 12.
    Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158:725–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Von Giesen HJ, Backer R, Hefter H, Arendt G. Depression does not influence basal ganglia-mediated psychomotor speed in HIV-1 infection. J Neuropsychiatry Clin Neurosci. 2001;13:88–94.CrossRefGoogle Scholar
  14. 14.
    Lawler K, Mosepele M, Ratcliffe S, Seloilwe E, Steele K, Nthobatsang R, et al. Neurocognitive impairment among HIV-positive individuals in Botswana: a pilot study. J Int AIDS Soc. 2010;13:15.PubMedCrossRefGoogle Scholar
  15. 15.
    Grant MM, Thase ME, Sweeney JA. Cognitive disturbance in outpatient depressed younger adults: evidence of modest impairment. Biol Psychiatry. 2001;50:35–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Weiland-Fiedler P, Erickson K, Waldeck T, Luckenbaugh DA, Pike D, Bonne O, Charney DS, Neumeister A. Evidence for continuing neuropsychological impairments in depression. J Affect Disord. 2004;82:253–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Letendre SL, McCutchan JA, Childers ME, Woods SP, Lazzaretto D, Heaton RK, et al. Enhancing antiretroviral therapy for human immunodeficiency virus cognitive disorders. Ann Neurol. 2004;56:416–23.PubMedCrossRefGoogle Scholar
  18. 18.
    Judd F, Cockram A, Komiti A, et al. Depressive symptoms reduced in individuals with HIV/AIDS treated with highly active antiretroviral therapy: a longitudinal study. Aust N Z J Psychiatry. 2000;34:1015–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Kalichman SC, Rompa D, Cage M. Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. J Nerv Ment Dis. 2000;188(10):662–70.PubMedCrossRefGoogle Scholar
  20. 20.
    Carey C, Woods SP, Gonzalez R, Conover E, Marcotte TD, Grant I, et al. Predictive validity of global deficit scores in detecting neuropsychological impairment in HIV infection. J Clin Exp Neuropsychol. 2004;26(3):307–19.PubMedCrossRefGoogle Scholar
  21. 21.
    Woods SP, Rippeth JD, Frol AB, Levy JK, Ryan E, Soukup VM, et al. Interrater reliability of clinical ratings and neurocognitive diagnoses in HIV. J Clin Exp Neuropsychol. 2004;26:759–78.PubMedCrossRefGoogle Scholar
  22. 22.
    Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H, et al. The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc. 2004;10:317–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Sousa MP, Lopes JS, Vieira R. Comparação entre a Escala de Hamilton e o Questionário de Beck na quantificação das depressões. Jornal do Médico. 1976;103:561–71.Google Scholar
  24. 24.
    Graffar M, Asiel M. Various results of the medicosocial study of the feminine population of a suburb of Brussels. Brux Med. 1957;37(41):1524–36.PubMedGoogle Scholar
  25. 25.
    Axelrod BN, Vanderploeg RD, Schinka JA. Comparing methods for estimating premorbid intellectual functioning—a review. Arch Clin Neuropsychol. 1999;14(4):341–6.PubMedGoogle Scholar
  26. 26.
    Griffin SL, Mindt MR, Rankin EJ, Ritchie AJ, Scott JG. Estimating premorbid intelligence: comparison of traditional and contemporary methods across the intelligence continuum. Arch Clin Neuropsychol. 2002;17(5):497–507.PubMedGoogle Scholar
  27. 27.
    Ball JD, Hart RP, Stutts ML, Turf E, Barth JT. Comparative utility of Barona Formulae, Wtar demographic algorithms, and WRAT-3 reading for estimating premorbid ability in a diverse research sample. Clin Neuropsychol. 2007;21(3):422–33.PubMedCrossRefGoogle Scholar
  28. 28.
    Barona A, Reynolds C, Chastain R. A demographically based index of premorbid intelligence for the WAIS-R. J Consult Clin Psychol. 1984;52:885–7.CrossRefGoogle Scholar
  29. 29.
    Basso R, Bornstein RA. Estimated premorbid intelligence mediates neurobehavioral change in individuals infected with HIV across 12 months. J Clin Exp Neuropsychol. 2000;22(2):208–18.PubMedCrossRefGoogle Scholar
  30. 30.
    Dawes S, Grant L. Neuroeognitive assessment of persons with HIV disease. Handb Clin Neurol. 2007;85:93–121.PubMedCrossRefGoogle Scholar
  31. 31.
    Griffin PT, Gerhardstein K. Cognitive testing in HIV/AIDS: a case for early assessment. HIV Clin. 2010;22(4):6–9.PubMedGoogle Scholar
  32. 32.
    Olley BO, Seedat S, Nei DG, Stein DJ. Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa. AIDS Patient Care STDS. 2004;18(8):481–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Valverde EE, Purcell DW, Waldrop-Valverde D, Malow R, Knowlton AR, Gomez CA, et al. Correlates of depression among HIV-positive women and men who inject drugs. J Acquir Immune Defic Syndr. 2007;46(Suppl 2):S96–100.PubMedGoogle Scholar
  34. 34.
    Rabkin JG. HIV and depression: 2008 review and update. Curr HIV/AIDS Rep. 2008;5(4):163–71.PubMedCrossRefGoogle Scholar
  35. 35.
    Adewuya AO, Afolabi MO, Ola BA, Ogundele OA, Ajibare AO, Oladipo BF, et al. Relationship between depression and quality of life in persons with HIV infection in Nigeria. Int J Psychiatry Med. 2008;38(1):43–51.PubMedCrossRefGoogle Scholar
  36. 36.
    Brechtl JR, Breitbart W, Galietta M, Krivo S, Rosenfeld B. The use of highly active antiretroviral therapy (HAART) in patients with advanced HIV infection: impact on medical, palliative care and quality of life outcomes. J Pain Symptom Manag. 2001;21:41–51.CrossRefGoogle Scholar
  37. 37.
    Cysique LA, Deutsch R, Atkinson JH, Young C, Marcotte TD, Dawson L, et al. Incident major depression does not affect neuropsychological functioning in HIV-infected men. J Int Neuropsychol Soc. 2007;13(1):1–11.PubMedCrossRefGoogle Scholar
  38. 38.
    Robertson KR, Smurzynski M, Parsons TD, Wu K, Bosch RJ, Wu J, et al. The prevalence and incidence of neurocognitive impairment in the HAART era. AIDS. 2007;21:1915–21.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of PsychiatryOporto Medical SchoolPortoPortugal
  2. 2.Serviço de Psiquiatria – Hospital de S. JoãoPortoPortugal

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