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The impact of ethnicity/race on the association between the Veterans Aging Cohort Study (VACS) Index and neurocognitive function among HIV-infected persons

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Abstract

The Veterans Aging Cohort Study (VACS) Index was developed as a risk index for health outcomes in HIV, and it has been consistently associated with mortality. It shows a significant, yet relatively weak, association with neurocognitive impairment, and little is known about its utility among ethnic/racial minority groups. We examined whether the association between the VACS Index and neurocognition differed by ethnic/racial group. Participants included 674 HIV-infected individuals (369 non-Hispanic whites, 111 non-Hispanic blacks, and 194 Hispanics). Neurocognitive function was assessed via a comprehensive battery. Scaled scores for each neurocognitive test were averaged to calculate domain and global neurocognitive scores. Models adjusting for demographics and HIV disease characteristics not included in the VACS Index showed that higher VACS Index scores (indicating poorer health) were significantly associated with worse global neurocognition among non-Hispanic whites. This association was comparable in non-Hispanic blacks, but nonsignificant among Hispanics (with similar results for English and Spanish speaking). We obtained comparable findings in analyses adjusting for other covariates (psychiatric and medical comorbidities and lifestyle factors). Analyses of individual neurocognitive domains showed similar results in learning and delayed recall. For other domains, there was an effect of the VACS Index and no significant interactions with race/ethnicity. Different components of the VACS Index were associated with global neurocognition by race/ethnicity. In conclusion, the association between the VACS Index and neurocognitive function differs by ethnic/racial group. Identifying key indicators of HIV-associated neurocognitive impairment by ethnic/racial group might play an important role in furthering our understanding of the biomarkers of neuroAIDS.

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References

  • American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington DC

  • Anez LM, Paris M Jr, Bedregal LE, Davidson L, Grilo CM (2005) Application of cultural constructs in the care of first generation Latino clients in a community mental health setting. J Psychiatr Pract 11(4):221–230

    Article  PubMed  Google Scholar 

  • Artiola i Fortuny L, Hermosillo Romo D, Heaton RK, Pardee RE (1999) Manual de Normas y Procedimientos para la Batería Neuropsicológica en Español. m Press, Tucson

    Google Scholar 

  • Beck AT, Steer RA (1993) Beck Depression Inventory Spanish Translation. The Psychological Corporation, San Antonio

    Google Scholar 

  • Beck AT, Erbaugh J, Ward CH, Mock J, Mendelsohn M (1961) An inventory for measuring depression. Arch Gen Psychiatry 4(6):561–571

    Article  CAS  PubMed  Google Scholar 

  • Beck AT, Steer RA, Ball R, Ranieri WF (1996a) Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. J Pers Assess 67(3):588–597

    Article  CAS  PubMed  Google Scholar 

  • Beck AT, Steer RA, Brown GK (1996b) Beck Depression Inventory -- Second Edition Manual. The Psychological Corporation, San Antonio

    Google Scholar 

  • Centers for Disease Control and Prevention (2013) HIV Surveillance Report, 2011 Vol. 23. Avaialable via http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_23.pdf. Accessed 09 Jun 2015

  • Chen NE, Gallant JE, Page KR (2012) A systematic review of HIV/AIDS survival and delayed diagnosis among Hispanics in the United States. J Immigr Minor Health 14(1):65–81

    Article  PubMed  PubMed Central  Google Scholar 

  • Cherner M, Suarez P, Lazzaretto D, Fortuny LA, Mindt MR, Dawes S, Marcotte T, Grant I, Heaton R (2007) Demographically corrected norms for the Brief Visuospatial Memory Test-revised and Hopkins Verbal Learning Test-revised in monolingual Spanish speakers from the U.S.-Mexico border region. Arch Clin Neuropsychol 22(3):343–353

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Clark CM, DeCarli C, Mungas D, Chui HI, Higdon R, Nunez J, Fernandez H, Negron M, Manly J, Ferris S, Perez A, Torres M, Ewbank D, Glosser G, van Belle G (2005) Earlier onset of Alzheimer disease symptoms in latino individuals compared with anglo individuals. Arch Neurol 62(5):774–778

    Article  PubMed  Google Scholar 

  • Cysique LA, Murray JM, Dunbar M, Jeyakumar V, Brew BJ (2010) A screening algorithm for HIV-associated neurocognitive disorders. HIV Med 11(10):642–649

    Article  CAS  PubMed  Google Scholar 

  • Cysique LA, Franklin D, Abramson I, Ellis RJ, Letendre S, Collier A, Clifford D, Gelman B, McArthur J, Morgello S, Simpson D, McCutchan JA, Grant I, Heaton RK (2011) Normative data and validation of a regression based summary score for assessing meaningful neuropsychological change. J Clin Exp Neuropsychol 33(5):505–522

    Article  PubMed  PubMed Central  Google Scholar 

  • Dennis AM, Napravnik S, Sena AC, Eron JJ (2011) Late entry to HIV care among Latinos compared with non-Latinos in a southeastern US cohort. Clin Infect Dis 53(5):480–487

    Article  PubMed  PubMed Central  Google Scholar 

  • Durvasula RS, Miller EN, Myers HF, Wyatt GE (2001) Predictors of neuropsychological performance in HIV positive women. J Clin Exp Neuropsychol 23(2):149–163

    Article  CAS  PubMed  Google Scholar 

  • First MB, Spitzer RL, Miriam G, Williams JBW (2002) Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P) Biometrics Research. New York State Psychiatric Institute, New York

    Google Scholar 

  • Guarnaccia PJ, Rodriguez O (1996) Concepts of culture and their role in the development of culturally competent mental health services. Hisp J Behav Sci 8(4):419–443

    Article  Google Scholar 

  • Guarnaccia PJ, Martinez Pincay I, Alegria M, Shrout PE, Lewis-Fernandez R, Canino G (2007) Assessing diversity among Latinos: results from the NLAAS. Hisp J Behav Sci 29(4):510–534

    Article  PubMed  PubMed Central  Google Scholar 

  • Hasin DS, Trautman KD, Miele GM, Samet S, Smith M, Endicott J (1996) Psychiatric research interview for substance and mental disorders (PRISM): Reliability for substance abusers. Am J Psychiatry 153(9):1195–1201

    Article  CAS  PubMed  Google Scholar 

  • Heaton RK, Grant I, Butters N, White DA, Kirson D, Atkinson JH, McCutchan JA, Taylor MJ, Kelly MD, Ellis RJ, Wolfson T, Velin R, Marcotte TD, Hesselink JR, Jernigan TL, Chandler J, Wallace M, Abramson I, the HNRC Group (1995) The HNRC 500--neuropsychology of HIV infection at different disease stages. HIV Neurobehavioral Research Center. J Int Neuropsychol Soc 1(3):231–251

    Article  CAS  PubMed  Google Scholar 

  • Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H, McCutchan JA, Reicks C, Grant I, the HNRC Group (2004) The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc 10(3):317–331

    Article  PubMed  Google Scholar 

  • Heaton RK, Cysique LA, Jin H, Shi C, Yu X, Letendre S, Franklin DR, Ake C, Vigil O, Atkinson JH, Marcotte TD, Grant I, Wu ZY (2008) Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China. J Neurovirol 14(6):536–549

    Article  PubMed  PubMed Central  Google Scholar 

  • Heaton RK, Clifford DB, Franklin DR, Woods SP, Ake C, Vaida F, Ellis RJ, Letendre SL, Marcotte TD, Atkinson JH, Rivera-Mindt M, Vigil OR, Taylor MJ, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, Abramson I, Gamst A, Fennema-Notestine C, Jernigan TL, Wong J, Grant I, CHARTER Group (2010) HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy CHARTER Study. Neurology 75(23):2087–2096

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, LeBlanc S, Corkran SH, Duarte NA, Clifford DB, Woods SP, Collier AC, Marra CM, Morgello S, Mindt MR, Taylor MJ, Marcotte TD, Atkinson JH, Wolfson T, Gelman BB, McArthur JC, Simpson DM, Abramson I, Gamst A, Fennema-Notestine C, Jernigan TL, Wong J, Grant I, The CHARTER & HNRC Group (2011) HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol 17(1):3–16

    Article  CAS  PubMed  Google Scholar 

  • Heaton RK, Franklin DR Jr., Deutsch R, Letendre S, Ellis RJ, Casaletto K, Marquine MJ, Woods SP, Vaida F, Atkinson JH, Marcotte TD, McCutchan JA, Collier AC, Marra CM, Clifford DB, Gelman BB, Sacktor N, Morgello S, Simpson DM, Abramson I, Gamst AC, Fennema-Notestine C, Smith DM, Grant I (2014) Neurocognitive Change in the Era of HIV Combination Antiretroviral Therapy: The Longitudinal CHARTER Study. Clin Infect Dis 60(3):473–480

  • Justice AC, McGinnis KA, Skanderson M, Chang CC, Gibert CL, Goetz MB, Rimland D, Rodriguez-Barradas MC, Oursler KK, Brown ST, Braithwaite RS, May M, Covinsky KE, Roberts MS, Fultz SL, Bryant KJ, VP Team (2010) Towards a combined prognostic index for survival in HIV infection: the role of ‘non-HIV’ biomarkers. HIV Med 11(2):143–151

    Article  CAS  PubMed  Google Scholar 

  • Justice AC, Freiberg MS, Tracy R, Kuller L, Tate JP, Goetz MB, Fiellin DA, Vanasse GJ, Butt AA, Rodriguez-Barradas MC, Gibert C, Oursler KA, Deeks SG, Bryant K, VP Team (2012) Does an index composed of clinical data reflect effects of inflammation, coagulation, and monocyte activation on mortality among those aging With HIV? Clin Infect Dis 54(7):984–994

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Justice AC, Modur SP, Tate JP, Althoff KN, Jacobson LP, Gebo KA, Kitahata MM, Horberg MA, Brooks JT, Buchacz K, Rourke SB, Rachlis A, Napravnik S, Eron J, Willig JH, Moore R, Kirk GD, Bosch R, Rodriguez B, Hogg RS, Thorne J, Goedert JJ, Klein M, Gill J, Deeks S, Sterling TR, Anastos K, Gange SJ (2013) Predictive accuracy of the Veterans Aging Cohort Study Index for mortality with HIV infection: A North American cross cohort analysis. J Acquir Immune Defic Syndr 62(2):149–163

    Article  PubMed  PubMed Central  Google Scholar 

  • Manly JJ, Miller SW, Heaton RK, Byrd D, Reilly J, Velasquez RJ, Saccuzzo DP, Grant I (1998) The effect of African-American acculturation on neuropsychological test performance in normal and HIV-positive individuals. The HIV Neurobehavioral Research Center (HNRC) Group. J Int Neuropsychol Soc 4(3):291–302

    CAS  PubMed  Google Scholar 

  • Manly JJ, Tang MX, Schupf N, Stern Y, Vonsattel JPG, Mayeux R (2008) Frequency and course of mild cognitive impairment in a multiethnic community. Ann Neurol 63(4):494–506

    Article  PubMed  PubMed Central  Google Scholar 

  • Marcotte TD, Heaton RK, Wolfson T, Taylor MJ, Alhassoon O, Arfaa K, Grant I (1999) The impact of HIV-related neuropsychological dysfunction on driving behavior. J Int Neuropsychol Soc 5(7):579–592

    Article  CAS  PubMed  Google Scholar 

  • Marquine MJ, Umlauf A, Rooney AS, Fazeli PL, Gouaux BD, Paul Woods S, Letendre SL, Ellis RJ, Grant I, Moore DJ (2014) The Veterans Aging Cohort Study Index is associated with concurrent risk for neurocognitive impairment. J Acquir Immune Defic Syndr 65(2):190–197

    Article  PubMed  PubMed Central  Google Scholar 

  • McCutchan JA, Marquie-Beck JA, FitzSimons CA, Letendre SL, Ellis RJ, Heaton RK, Wolfson T, Rosario D, Alexander TJ, Marra C, Ances BM, Grant I, Grp C (2012) Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder. Neurology 78(7):485–492

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mindt MR, Byrd D, Ryan EL, Robbins R, Monzones J, Arentoft A, Germano KK, Morgello S, Henniger D (2008) Characterization and sociocultural predictors of neuropsychological test performance in HIV+ Hispanic individuals. Cultur Divers Ethnic Minor 14(4):315–325

    Article  Google Scholar 

  • Rippeth JD, Heaton RK, Carey CL, Marcotte TD, Moore DJ, Gonzalez R, Wolfson T, Grant I, the HNRC Group (2004) Methamphetamine dependence increases risk of neuropsychological impairment in HIV infected persons. J Int Neuropsychol Soc 10(1):1–14

    Article  CAS  PubMed  Google Scholar 

  • Ryan EL, Baird R, Mindt MR, Byrd D, Monzones J, Bank SM, HIVBB Manhattan (2005) Neuropsychological impairment in racial/ethnic minorities with HIV infection and low literacy levels: effects of education and reading level in participant characterization. J Int Neuropsychol Soc 11(7):889–898

    Article  PubMed  PubMed Central  Google Scholar 

  • Shapiro MF, Morton SC, McCaffrey DF, Senterfitt JW, Fleishman JA, Perlman JF, Athey LA, Keesey JW, Goldman DP, Berry SH, Bozzette SA, Consortium H (1999) Variations in the care of HIV-infected adults in the United States—results from the HIV Cost and Services Utilization Study. J Am Med Assoc 281(24):2305–2315

    Article  CAS  Google Scholar 

  • Swindells S, Cobos DG, Lee N, Lien EA, Fitzgerald AP, Pauls JS, Anderson JR (2002) Racial/ethnic differences in CD4 T cell count and viral load at presentation for medical care and in follow-up after HIV-1 infection. AIDS 16(13):1832–1834

    Article  PubMed  Google Scholar 

  • Tang MX, Cross P, Andrews H, Jacobs DM, Small S, Bell K, Merchant C, Lantigua R, Costa R, Stern Y, Mayeux R (2001) Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology 56(1):49–56

    Article  CAS  PubMed  Google Scholar 

  • Tate JP, Justice AC, Hughes MD, Bonnet F, Reiss P, Mocroft A, Nattermann J, Lampe FC, Bucher HC, Sterling TR, Crane HM, Kitahata MM, May M, Sterne JA (2013) An internationally generalizable risk index for mortality after one year of antiretroviral therapy. AIDS 27(4):563–572

    Article  PubMed  PubMed Central  Google Scholar 

  • Turner BJ, Cunningham WE, Duan N, Andersen RM, Shapiro MF, Bozzette SA, Nakazono T, Morton S, Crystal S, St Clair P, Stein M, Zierler S (2000) Delayed medical care after diagnosis in a US national probability sample of persons infected with human immunodeficiency virus. Arch Intern Med 160(17):2614–2622

    Article  CAS  PubMed  Google Scholar 

  • Wojna V, Skolasky RL, Hechavarria R, Mayo R, Selnes O, McArthur JC, Melendez LM, Maldonado E, Zorrilla CD, Garcia H, Kraiselburd E, Nath A (2006) Prevalence of human immunodeficiency virus-associated cognitive impairment in a group of Hispanic women at risk for neurological impairment. J Neurovirol 12(5):356–364

    Article  PubMed  Google Scholar 

  • Woods SP, Rippeth JD, Frol AB, Levy JK, Ryan E, Soukup VM, Hinkin CH, Lazzaretto D, Cherner M, Marcotte TD, Gelman BB, Morgello S, Singer EJ, Grant I, Heaton RK (2004) Interrater reliability of clinical ratings and neurocognitive diagnoses in HIV. J Clin Exp Neuropsychol 26(6):759–778

    Article  PubMed  Google Scholar 

  • World Health Organization (1997) Composite International Diagnostic Interview. Geneva

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Acknowledgments

This work was supported by the National Institutes of Health [grant numbers P30 MH062512, U24 MH100928, U01 MH083506, R24 MH59745, P01 DA12065, T32MH019934, R25MH080663, K23 MH105297 and 1 K99 AG048762-01]. The San Diego HIV Neurobehavioral Research Center [HNRC] group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the Veterans Affairs San Diego Healthcare System, and includes the following: Director: Robert K. Heaton, Ph.D., Co-Director: Igor Grant, M.D.; Associate Directors: J. Hampton Atkinson, M.D., Ronald J. Ellis, M.D., Ph.D., and Scott Letendre, M.D.; Center Manager: Thomas D. Marcotte, Ph.D.; Jennifer Marquie-Beck, M.P.H.; Melanie Sherman; Neuromedical Component: Ronald J. Ellis, M.D., Ph.D. (P.I.), Scott Letendre, M.D., J. Allen McCutchan, M.D., Brookie Best, Pharm.D., Rachel Schrier, Ph.D., Debra Rosario, M.P.H.; Neurobehavioral Component: Robert K. Heaton, Ph.D. (P.I.), J. Hampton Atkinson, M.D., Steven Paul Woods, Psy.D., Thomas D. Marcotte, Ph.D., Mariana Cherner, Ph.D., David J. Moore, Ph.D., Matthew Dawson; Neuroimaging Component: Christine Fennema-Notestine, Ph.D. (P.I.), Monte S. Buchsbaum, M.D., John Hesselink, M.D., Sarah L. Archibald, M.A., Gregory Brown, Ph.D., Richard Buxton, Ph.D., Anders Dale, Ph.D., Thomas Liu, Ph.D.; Neurobiology Component: Eliezer Masliah, M.D. (P.I.), Cristian Achim, M.D., Ph.D.; Neurovirology Component: David M. Smith, M.D. (P.I.), Douglas Richman, M.D.; International Component: J. Allen McCutchan, M.D., (P.I.), Mariana Cherner, Ph.D.; Developmental Component: Cristian Achim, M.D., Ph.D.; (P.I.), Stuart Lipton, M.D., Ph.D.; Participant Accrual and Retention Unit: J. Hampton Atkinson, M.D. (P.I.), Jennifer Marquie-Beck, M.P.H.; Data Management and Information Systems Unit: Anthony C. Gamst, Ph.D. (P.I.), Clint Cushman; Statistics Unit: Ian Abramson, Ph.D. (P.I.), Florin Vaida, Ph.D. (Co-PI), Reena Deutsch, Ph.D., Anya Umlauf, M.S.

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Authors and Affiliations

  1. Department of Psychiatry, University of California, San Diego, CA, USA

    M. J. Marquine, M. Sakamoto, A. Rooney, A. Umlauf, B. Gouaux, D. Franklin, M. Cherner, R. K. Heaton, I. Grant & D. J. Moore

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

    C. Dufour & S. Letendre

  3. Psychology Department, University of Alabama, Birmingham, CA, USA

    P. Fazeli

  4. Department of Neurosciences, University of California, San Diego, CA, USA

    R. Ellis

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  1. M. J. Marquine
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  2. M. Sakamoto
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  3. C. Dufour
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  4. A. Rooney
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  5. P. Fazeli
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  6. A. Umlauf
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  7. B. Gouaux
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  8. D. Franklin
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  9. R. Ellis
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  10. S. Letendre
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  12. R. K. Heaton
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  13. I. Grant
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Correspondence to M. J. Marquine.

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Marquine, M.J., Sakamoto, M., Dufour, C. et al. The impact of ethnicity/race on the association between the Veterans Aging Cohort Study (VACS) Index and neurocognitive function among HIV-infected persons. J. Neurovirol. 22, 442–454 (2016). https://doi.org/10.1007/s13365-015-0411-6

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