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Effort and neuropsychological performance in HIV-infected individuals on stable combination antiretroviral therapy

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Abstract

The expression of cognitive symptoms associated with HIV varies over time and across individuals. This pattern may reflect transient contextual factors, including the degree of effort exerted by individuals undergoing cognitive testing. The present study examined whether effort corresponds to the expression of persistent HIV-related cognitive impairment among individuals receiving combination antiretroviral therapy (cART). HIV+ individuals (n = 111) averaged 48.2 (14.9) years of age and 13.0 (2.7) years of education and HIV− individuals (n = 92) averaged 34.9 (17.2) years of age and 13.5 (1.9) years of education. Participants completed a neuropsychological battery and a clinically validated measure of effort (Test of Memory Malingering, trial 1). Results revealed that the vast majority of HIV+ (85%) and HIV− (89%) individuals performed above published guidelines for adequate effort. Furthermore, the expression of cognitive impairment in HIV was not related to effort performance. The results were unchanged when examining HIV+ individuals with and without viral suppression. Finally, disability and disability-seeking status, and a proxy measure of apathy did not correspond to effort levels in HIV+ individuals. These findings suggest that variability in the expression of cognitive impairment in the cART era is unlikely to represent overt effort failures or other confounds unrelated to the disease. Persistent cognitive impairment in HIV likely represents historical and/or ongoing disease mechanisms despite otherwise successful treatment.

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Acknowledgements

There are no actual or potential conflicts of interest for any of the authors on this manuscript. Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). Funding was also supported by the National Institute of Nursing Research (NR012907, NR014449, and NR012657). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.

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  1. Department of Psychological Sciences, University of Missouri- St. Louis, St. Louis, USA

    Robert Paul & Laurie M. Baker

  2. Missouri Institute of Mental Health, St. Louis, USA

    Robert Paul & Laurie M. Baker

  3. Department of Neurology, Washington University in St. Louis, St. Louis, USA

    Gina Rhee, Sarah A. Cooley & Beau M. Ances

  4. Department of Family Medicine and Public Health, Division of Biostatistics and Bio-informatics, University of California San Diego, San Diego, CA, USA

    Florin Vaida

  5. Department of Neurology, Washington University in Saint Louis School of Medicine, Campus Box 8111, 660 South Euclid Avenue, St. Louis, MO, 63110, USA

    Beau M. Ances

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Correspondence to Beau M. Ances.

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Paul, R., Rhee, G., Baker, L.M. et al. Effort and neuropsychological performance in HIV-infected individuals on stable combination antiretroviral therapy. J. Neurovirol. 23, 725–733 (2017). https://doi.org/10.1007/s13365-017-0557-5

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