How "asymptomatic" is HIV-associated asymptomatic neurocognitive impairment?

Type: Poster
Title: How "asymptomatic" is HIV-associated asymptomatic neurocognitive impairment?
Authors: Blackstone K, Moore DJ, Woods SP, Morgan EE, Franklin DR, Ellis RJ, Letendre SL, Grant I, Heaton RK, and the CHARTER Group
Date: 03-05-2012
Abstract:Background: The most prevalent form of HIV-associated neurocognitive disorders (HAND) is asymptomatic neurocognitive impairment (ANI), which affects approximately one-third of the HIV+ population. ANI is asymptomatic meaning that the observed neurocognitive impairment does not affect self-reported daily functioning abilities. However, self-report may be insensitive to mild declines in everyday functioning, thereby raising questions about whether individuals with ANI might experience clinically meaningful functional declines not detected by current standards of practice. Methods: We assessed 578 HIV-infected participants from the CHARTER cohort with a comprehensive neuropsychological (NP) battery, self-report questionnaires of cognitive complaints and everyday functioning, and 2 performance-based tasks measuring employment capacity (Valpar COMPASS) and medication management (Medication Management Test-Revised, MMT-R). Three hundred and forty-five persons were classified as NP normal, 175 met criteria for ANI (no self-reported functional problems), and 58 met criteria for symptomatic HAND (mild neurocognitive disorder [MND] (n = 44) and HIV-associated dementia [HAD] (n = 14)). Results: The 3 groups were demographically comparable and similar across most psychiatric and HIV disease variables, but the symptomatic HAND group reported significantly more depressive symptoms and had lower current CD4 counts. After controlling for current CD4 and depressive symptoms, the ANI participants had worse employment capacity than the NP-normal participants, but were comparable to the MND/HAD group (p’s <0.001), who did not differ from each other (p >0.10). There were no between-group differences on the test of medication management (p >0.10). Conclusions: As compared to NP-normal HIV+ persons, individuals with ANI evidenced comparable deficits in vocational capacity to those with symptomatic HAND, suggesting that ANI may be a much less benign condition than is widely perceived. These findings are consistent with prior research showing that even mild NP impairment is associated with worse functional outcomes and highlight the importance of incorporating performance-based tests of everyday functioning when diagnosing HAND.