A composite of multisystem injury and neurocognitive impairment in HIV infection: association with everyday functioning.

TitleA composite of multisystem injury and neurocognitive impairment in HIV infection: association with everyday functioning.
Publication TypeJournal Article
Year of Publication2018
AuthorsMarquine, MJ, Flores, I, Kamat, R, Johnson, N, Umlauf, A, Letendre, S, Jeste, D, Grant, I, Moore, D, Heaton, RK
JournalJ Neurovirol
Volume24
Issue5
Pagination549-556
Date Published2018 10
ISSN1538-2443
KeywordsAdolescent, Adult, Aged, Cognitive Dysfunction, Cohort Studies, Cross-Sectional Studies, Female, HIV Infections, Humans, Male, Middle Aged, Quality of Life, Severity of Illness Index, Young Adult
Abstract

The Veterans Aging Cohort Study (VACS) Index is a composite marker of multisystem injury among HIV-infected persons. We aimed to examine its cross-sectional association with functional outcomes, after considering neurocognitive impairment (NCI) and other well-established correlates of everyday functioning among HIV-infected persons. Participants included 670 HIV-infected adults (ages 18-76; 88% male; 63% non-Hispanic White; median current CD4 = 404 cells/mm; 67% on antiretroviral therapy; AIDS = 63%) enrolled in observational studies at the University of California San Diego HIV Neurobehavioral Research Program. Functional outcomes were assessed via self-report measures of declines in activities of daily living, perceived cognitive symptoms in daily life, and employment status. NCI was assessed via a comprehensive neurocognitive test battery and defined based on established methods. Covariates examined included demographics, HIV disease characteristics not included in the VACS Index, and psychiatric comorbidities. The VACS Index was computed via standard methods and categorized based on its distribution. Results from multivariable regression models showed that both higher VACS Index scores (indicative of worse health) and the presence of NCI were independently associated with declines in activities of daily living, increased cognitive symptoms in daily life, and unemployment. These independent effects remained after adjusting for significant covariates. In conclusion, the VACS Index may be a useful tool for identifying HIV-infected patients at high risk for everyday functioning problems. Considering factors such as NCI, historical HIV disease characteristics, and current mood might be particularly important to enhance the predictive power of the VACS Index for functional status among HIV-infected persons.

DOI10.1007/s13365-018-0643-3
Alternate JournalJ Neurovirol
PubMed ID29777462
PubMed Central IDPMC6202221
Grant ListK23 MH105297 / MH / NIMH NIH HHS / United States
U24 MH100928 / MH / NIMH NIH HHS / United States
R24 MH059745 / MH / NIMH NIH HHS / United States
R24MH59745 / NH / NIH HHS / United States
R25AG043364 / NH / NIH HHS / United States
P01DA12065 / NH / NIH HHS / United States
U01MH083506 / NH / NIH HHS / United States
P30MH062512 / NH / NIH HHS / United States
R25 AG043364 / AG / NIA NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
P01 DA012065 / DA / NIDA NIH HHS / United States
R01MH099987 / NH / NIH HHS / United States
U01 MH083506 / MH / NIMH NIH HHS / United States
R01 MH099987 / MH / NIMH NIH HHS / United States
K23MH105297 / NH / NIH HHS / United States