Neurocognitive Impairment Common Among Youth with HIV

Approximately two-thirds of HIV positive young adults showed evidence of HIV-associated neurocognitive disorders (HAND), including impaired memory and fine motor control, according to a report in the August 21, 2013, advance edition of the Journal of Adolescent Health.

Sharon Nichols from the University of California at San Diego and colleagues looked at prevalence of and risk factors for HAND among 220 youth (age 18-24) with behaviorally acquired HIV (i.e., not perinatal infection) who had not yet started antiretroviral therapy.

The researchers found that 67% met criteria for HAND, but almost all (96%) were asymptomatic and deficits were only apparent with specialized testing. Risk factors for HAND included longer time since HIV infection, lower CD4 T-cell count, and heavy alcohol use.

"Research is needed to determine the impact of such neuropsychiatric morbidity on mental health and HIV disease treatment outcomes (e.g., non-adherence) and transition to independent living responsibilities in HIV-infected youth, as well as its long-term trajectory and possible responsiveness to cognitive rehabilitation and pharmacotherapy," the researchers concluded.

Below is an edited excerpt from a press release issued by the National Institutes of Health describing the research and its findings in more detail.

Increased Risk of Neurological, Cognitive Deficits in Youth with HIV

NIH network finding underscores need for youth with HIV to obtain prompt treatment

August 29, 2013 -- More than 65 percent of HIV-infected youth had mild to moderate impairments in fine-motor skills, memory, and other cognitive skills, although not enough to affect day-to-day functioning for most, according to a National Institutes of Health network study.

The study authors stressed that the findings underscore the need for youth with HIV to receive medical care as soon as they are diagnosed with the virus.

Previous studies have shown that such cognitive impairments occur commonly in adults with HIV. The authors believe theirs is the first to document such impairments in youth with HIV. The researchers cannot tell from their study whether the impairments are due to HIV infection or to some other factors common to the youths who took part in the study.

"Our findings don’t change the fact that youth with HIV fare better if they are receiving medical care and appropriate treatment for HIV," said co-author Bill Kapogiannis, MD, of the Maternal and Pediatric Infectious Disease Branch at the Eunice Kennedy ShriverNational Institute of Child Health and Human Development (NICHD), one of three NIH institutes supporting the study. "Getting into care will help them maintain their own health, and help keep them from passing the virus on to others."

The U.S. Centers for Disease Control and Prevention provides information for youth with HIV at www.cdc.gov/vitalsigns/hivamongyouth.

The researchers found that youth who had been infected with HIV longer or who had a more advanced HIV infection were more likely to have neurological and cognitive impairments. Additionally, those who were heavy consumers of alcoholic beverages also had more severe impairments.

Dr. Kapogiannis conducted the study with first author Sharon L. Nichols, PhD, of the University of California, San Diego (UCSD), researchers at Westat, Inc., in Rockville, Md.; Children’s Diagnostic and Treatment Center, Inc., in Fort Lauderdale, Fla.; the University of Miami; UCSD; and collaborators in the NIH-funded Adolescent Trials Network for HIV/AIDS Interventions.

In addition to the NICHD, the researchers received support from the National Institute on Drug Abuse and the National Institute of Mental Health.

The study findings appear in the Journal of Adolescent Health.

To conduct the study, the researchers analyzed health information from more than 200 young adults age 18 to 24, who had been diagnosed with HIV within the previous two years.

The study participants’ received a battery of tests that evaluated their attention, memory, coordination and other motor skills, verbal skills and reading ability. The researchers found that 69 percent of the participants had a deficit in one or more of these areas. Heavy alcohol users were more likely to have more pronounced deficits that were other youth in the study.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at www.nichd.nih.gov.

9/3/13

Reference

SL Nichols, J Bethel, PA Garvie, et al. Neurocognitive Functioning in Antiretroviral Therapy-Naive Youth With Behaviorally Acquired Human Immunodeficiency Virus. Journal of Adolescent Health. August 21, 2013(Epub ahead of print).

Other Source

National Institutes of Health. Increased Risk of Neurological, Cognitive Deficits in Youth with HIV. Press release. August 29, 2013.