A composite of multisystem injury and neurocognitive impairment in HIV infection: association with everyday functioning.
Title | A composite of multisystem injury and neurocognitive impairment in HIV infection: association with everyday functioning. |
Publication Type | Journal Article |
Year of Publication | 2018 |
Authors | Marquine, MJ, Flores, I, Kamat, R, Johnson, N, Umlauf, A, Letendre, S, Jeste, D, Grant, I, Moore, D, Heaton, RK |
Journal | J Neurovirol |
Volume | 24 |
Issue | 5 |
Pagination | 549-556 |
Date Published | 2018 10 |
ISSN | 1538-2443 |
Keywords | Adolescent, 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. |
DOI | 10.1007/s13365-018-0643-3 |
Alternate Journal | J Neurovirol |
PubMed ID | 29777462 |
PubMed Central ID | PMC6202221 |
Grant List | K23 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 |