Functional Consequences of HIV-Associated Neuropsychological Impairment

Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
Neuropsychology Review (Impact Factor: 4.59). 07/2009; 19(2):186-203. DOI: 10.1007/s11065-009-9095-0
Source: PubMed


This review focuses on the "real world" implications of infection with HIV/AIDS from a neuropsychological perspective. Relevant literature is reviewed which examines the relationships between HIV-associated neuropsychological impairment and employment, driving, medication adherence, mood, fatigue, and interpersonal functioning. Specifically, the relative contributions of medical, cognitive, psychosocial, and psychiatric issues on whether someone with HIV/AIDS will be able to return to work, adhere to a complicated medication regimen, or safely drive a vehicle will be discussed. Methodological issues that arise in the context of measuring medication adherence or driving capacity are also explored. Finally, the impact of HIV/AIDS on mood state, fatigue, and interpersonal relationships are addressed, with particular emphasis on how these variables interact with cognition and independent functioning. The purpose of this review is to integrate neuropsychological findings with their real world correlates of functional behavior in the HIV/AIDS population.

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Available from: Mark Ettenhofer, Jan 30, 2014
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    • "Accordingly, we did not find significant differences in BMD, osteopenia, osteoporosis or in the percentage of impaired IIEF-15 scores between HIV-infected men with or without T deficiency. All these elements result in the overlap of signs and symptoms of androgen deficiency with those related to HIV infection [27], [49], [50]. This result confirms the low specificity of signs and symptoms of androgen deficiency in men with HIV infection [17], [51], suggesting that confounding elements should be considered when diagnosing androgen deficiency in this context [33], as in other chronic illnesses [8], [49]. "
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    ABSTRACT: Testosterone (T) deficiency remains a poorly understood issue in men with Human Immunodeficiency Virus (HIV). We investigated the gonadal status in HIV-infected men in order to characterize T deficiency and to identify predictive factors for low serum T. We performed a cross-sectional, observational study on 1325 consecutive HIV male outpatients, most of them having lipodystrophy. Serum total T<300 ng/dL was used as the threshold for biochemical T deficiency. Morning serum total T, luteinizing hormone (LH), estradiol, HIV parameters, and body composition parameters by CT-scan and Dual-Energy-X-ray-Absorptiometry were measured in each case. Sexual behavior was evaluated in a subset of 247 patients. T deficiency was found in 212 subjects, especially in the age range 40-59, but was frequent even in younger patients. T deficiency occurred mainly in association with low/normal serum LH. Adiposity was higher in subjects with T deficiency (p<0.0001) and both visceral adipose tissue and body mass index were the main negative predictors of serum total T. Osteoporosis and erectile dysfunction were present in a similar percentage in men with or without T deficiency. Premature decline of serum T is common (16%) among young/middle-aged HIV-infected men and is associated with inappropriately low/normal LH and increased visceral fat. T deficiency occurs at a young age and may be considered an element of the process of premature or accelerated aging known to be associated with HIV infection. The role of HIV and/or HIV infection treatments, as well as the role of the general health state on the gonadal axis, remains, in fact, to be elucidated. Due to the low specificity of signs and symptoms of hypogonadism in the context of HIV, caution is needed in the diagnosis of hypogonadism in HIV-infected men with biochemical low serum T levels.
    PLoS ONE 12/2011; 6(12):e28512. DOI:10.1371/journal.pone.0028512 · 3.23 Impact Factor
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    • "The functional consequences for activities of everyday living can be insidious and disruptive (Gorman et al. 2009), underscoring the relevance of their detection with quantitative assessment and identification of their neural underpinnings through in vivo neuroimaging examination. Prominent in the constellation of compromised function are movement disorders (e.g., Mattos et al. 2002; Nath et al. 1987) involving signs of extrapyramidal dysfunction manifest as slowed psychomotor speed, impaired manual dexterity (e.g., Fama et al. 2007; Gorman et al. 2009; Heaton et al. 1995; Maki et al. 2009; Sacktor et al. 2003; Sassoon et al. 2007; Woods et al. 2009), and disturbance of gait and balance (e.g., Fama et al. 2007; Robertson et al. 2006). Motor slowing has been attributed, for example, to disturbance of frontostriatal systems, affected early in the course of HIV infection (Chang et al. 2000; Paul et al. 2007; Sclar et al. 2000; von Giesen et al. 2001), or to diffuse white matter abnormalities, noted as hyperintense signal on MRI (Archibald et al. 2004; Ernst et al. 1999; Heindel et al. 1994). "
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    ABSTRACT: Postural instability occurs in HIV infection, but quantitative balance tests in conjunction with neuroimaging are lacking. We examined whether infratentorial brain tissue volume would be deficient in nondemented HIV-infected individuals and whether selective tissue deficits would be related to postural stability and psychomotor speed performance. The 123 participants included 28 men and 12 women with HIV infection without dementia or alcohol use disorders, and 40 men and 43 women without medical or psychiatric conditions. Participants completed quantitative balance testing, Digit Symbol test, and a test of finger movement speed and dexterity. An infratentorial brain region, supratentorial ventricular system, and corpus callosum were quantified with MRI-derived atlas-based parcellation, and together with archival DTI-derived fiber tracking of pontocerebellar and internal and external capsule fiber systems, brain measures were correlated with test performance. The tissue ratio of the infratentorium was ~3% smaller in the HIV than control group. The HIV group exhibited performance deficits in balancing on one foot, walking toe-to-heel, Digit Symbol substitution task, and time to complete all Digit Symbol grid boxes. Total infratentorial tissue ratio was a significant predictor of balance and Digit Symbol scores. Balance scores did not correlate significantly with ventricular volumes, callosal size, or internal or external capsule fiber integrity but did so with indices of pontocerebellar tract integrity. HIV-infected individuals specifically recruited to be without complications from alcohol use disorders had pontocerebellar tissue volume deficits with functional ramifications. Postural stability and psychomotor speed were impaired and attributable, at least in part, to compromised infratentorial brain systems.
    Brain Imaging and Behavior 03/2011; 5(1):12-24. DOI:10.1007/s11682-010-9107-y · 4.60 Impact Factor
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    • "Moreover, HIV-1 induced dysfunctions of the NSPCs have been implicated with long-term consequences in the cognitive functions of infected individuals (Schwartz and Major, 2006). Neurotropic viruses like HIV and BDV have shown to have psychiatric manifestations, which sometimes trigger mood disorders in patients (Carbone et al., 2001; Gorman, 2009). A major challenge now is to develop models of chronic viral infections in perinatal/postnatal period which via disruption of NSPC growth and neurogenesis, might lead to the onset of neurobehavioral abnor- malities. "
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    ABSTRACT: Viral infections in the prenatal (during pregnancy) and perinatal period have been a common cause of brain malformation. Besides the immediate neurological dysfunctions, virus infections may critically affect CNS development culminating in long-term cognitive deficits. Most of these neurotropic viruses are most damaging at a critical stage of the host, when the brain is in a dynamic stage of development. The neuropathology can be attributed to the massive neuronal loss induced by the virus as well as lack of CNS repair owing to a deficit in the neural stem/progenitor cell (NSPC) pool or aberrant formation of new neurons from NSPCs. Being one of the mitotically active populations in the post natal brain, the NSPCs have emerged as the potential targets of neurotropic viruses. The NSPCs are self-renewing and multipotent cells residing in the neurogenic niches of the brain, and, therefore, hampering the developmental fate of these cells may adversely affect the overall neurogenesis pattern. A number of neurotropic viruses utilize NSPCs as their cellular reservoirs and often establish latent and persistent infection in them. Both HIV and Herpes virus infect NSPCs over long periods of time and reactivation of the virus may occur later in life. The virus infected NSPCs either undergoes cell cycle arrest or impaired neuronal or glial differentiation, all of which leads to impaired neurogenesis. The disturbances in neurogenesis and CNS development following neurotropic virus infections have direct implications in the viral pathogenesis and long-term neurobehavioral outcome in infected individuals.
    Neurochemistry International 02/2011; 59(3):357-66. DOI:10.1016/j.neuint.2011.02.020 · 3.09 Impact Factor
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