Many HIV-Positive Patients Suffer Cognitive Impairments That Can Affect Treatment Outcomes

Overall cognitive performance was below average in a sample of patients with HIV who were referred for neurocognitive evaluation. Especially affected were areas involving memory. These results were reported in a study presented at the 2013 United States Conference on AIDS.

Neurocognitive impairment (NCI) is known to be common in people living with HIV/AIDS (PLWH). NCI has been shown to have a negative effect on adherence to highly active antiretroviral therapy (HAART). Nonadherence ultimately results in increased viral load, lower CD4 levels, and drug resistance. Due to the association of NCI with nonadherence to therapy, HIV patients are often assessed for NCI using a short cognitive screen called the RBANS (Repeatable Battery for the Assessment of Neuropsychological Status), which aids in the planning and adjustment of their treatment regimes, as necessary.

According to Andrea LaPlante, Psychology Fellow at Louisiana State University Health Sciences Center in New Orleans, RBANS data have been examined for patients with conditions such as Huntington's disease, Alzheimer's disease, multiple sclerosis, and Parkinson's; however, there is a lack of published data concerning the pattern of NCI for PLWH, as measured by the RBANS. The purpose of the new study was to determine the overall level of NCI in HIV patients and to identify what cognitive domains were the most affected in this patient population.

The study retroactively collected and examined RBANS data from a sample of 66 HIV patients who were referred for assessment of neurocognitive function. The mean age of the group was 49 years. As far as racial demographics, 53% were African-American, 39% Caucasian, and 8% were listed as “other.” Sixty-five percent of the patients were male, 35% were female. Total RBANS scores, index scores, and subset scores were generated and statistically analyzed.

The average total RBANS score of the study group was 75.97 (SD = 18.40), which is interpreted as a borderline level of impairment. The cognitive domains that showed the greatest impairment were Immediate Memory (average score, 73.59, SD = 19.27) and Delayed Memory (average score, 74.76, SD = 22.28).

RBANS assessment of Immediate Memory involves List Learning and Story Memory, while assessment of Delayed Memory involves List Recall, List Recognition, Story Recall, and Figure Recall. The study group achieved low average scores in the domains of Attention (average score, 81.20, SD = 20.01), Language (average score, 85.80, SD = 17.70), and Visuospatial/Constructional Skills (average score, 87.48, SD = 19.80)

The researchers concluded that the cognitive impairment of HIV patients, as measured by the RBANS, is likely to interfere with their adherence to therapy by affecting their ability to remember to take medications and keep their medical appointments. The study team also recommended further research to identify other factors, such as mental illness, substance abuse, viral loads, and CD4 counts, which can affect performance on the RBANS. Studies comparing RBANS performance for HIV patients to a control group of HIV-negative individuals are also necessary.