Brain impairment in people with HIV may not be as common as we thought

[red_Dragon888]

http://www.aidsmap.com/page/1758873/


Two studies presented at the17th British HIV Association (BHIVA) conference last week suggest that the proportion of people who have subtle brain impairment due to HIV may not be as high as previously thought, and may in fact be little higher than in the general population.

Several studies measuring neurocognitive impairment (deficits in memory, thinking and movement) in people with HIV in the last few years have concluded that a high proportion of people with HIV have subtle impairments. These may not cause symptoms that interfere with daily life, but can be detected by psychological tests.

About 16% of the general population has some degree of neurocognitive deficit. It therefore caused a lot of concern when in 2010 the large CHARTER trial in the USA found that 52% of 1526 people with HIV had evidence of neurocognitive impairment.

A quarter of these people had other conditions that were probably the major cause of their brain impairment, but that still meant that 39% of all HIV-positive patients had brain impairment without any other obvious cause, and 36% of patients who had never had an HIV-related illness. Of these 71%, or 28% of the entire group, had no obvious neurological symptoms. CHARTER, therefore, suggested that HIV more than doubled the risk of brain impairment in otherwise healthy people, raising concerns that it might become even more common with age.

One study presented at BHIVA, however, found a rate of asymptomatic neurocognitive impairment of only 19% in a group of patients with suppressed viral loads, very little in excess of the general population rate. Another study found that young people who had been born with HIV had rates of neurocognitive impairment no higher than their HIV-negative siblings. This study, and a third study that looked at rates of neurocognitive impairment in the over-50s, found some evidence that some psychological tests that rely on self-report might not be detecting actual difficulties in thinking and memory, but rather people’s fear of them.     
The St Mary’s Study
Dr Lucy Garvey from St Mary’s and Hammersmith Hospitals in west London reported on a survey (which won a prize for best presentation at the conference) of 101 patients who were on stable antiretroviral therapy without any obvious neurological symptoms or other illnesses. They had all had HIV for more than six months.

The study subjects were given two types of psychological test, a 20-minute computerised cognitive assessment test called Cogstate, and the International HIV Dementia Scale (IHDS), a short, validated screening test for dementia employing three simple memory and motor tasks.   

Neurocognitive impairment was defined as scores more than one standard deviation below the mean age-matched population data in at least two areas of functioning - roughly within the lowest one-sixth of performance scores.

The median age of the subjects was 53, and the majority (77%) where white men. They had been HIV-positive for an average of 14 years, with a mean CD4 count of 559 and lowest-ever CD4 count (nadir) of 185. A high proportion – 25% - had hepatitis C, which is also associated with neurocognitive disorders.

The overall rate of neurocognitive impairment was 19% in this group, only 3% above the rate in the general population. The pattern of domains affected was familiar from other studies of people with HIV, in that fine muscular movement, multitasking and executive function (prioritising and planning) were particularly impaired, and CD4 nadir was associated with a high IHDS score, but nonetheless the impairments seen were slight.

“Many cohorts have reported HIV-associated neurological disorder, but their antiretroviral therapy status and health have been widely variable,” commented Dr Garvey. “This is one of the first studies to look at neurocognitive impairment only in stable HIV-asymptomatic patients on suppressive antiretroviral therapy.”

The St Mary’s team will now conduct further studies to look at neurocognitive disorder in drug-naive patients with unsuppressed HIV.
Young people and brain impairment
The results from this study were echoed by another study from St Mary’s that looked at neurocognitive function in young people who had been born with HIV. It studied 31 young people aged 16-25 (mean age 20) and compared their performance with 14 of their HIV-negative siblings. The two groups were matched for age, ethnicity (both 85% black African) and gender (33% and 29% respectively were male in the positive and negative groups). Seventy-nine per cent of the positive subjects were on antiretrovirals of whom 70% were virally suppressed (55% of the whole group).

These subjects were given the Cogstate computerised tests and the IHDS, and were also given the prospective and retrospective memory scale (PRMQ) questionnaire, a self-reported rating of problems with recall and retention of information. A minority of both groups were also given an MRI brain scan to detect signs of inflammation.

The positive and negative group had identical scores on the IHDS and on the Cogstate test in all domains. The PRMQ score was significantly worse (p=0.023) for the HIV-positive young people, and there were also high levels of activity of certain neurotransmitters in the basal ganglia area of the brain, a finding seen in other studies.


However presenter Jane Ashby commented that the PRMQ questionnaire, as a self-report, could measure subjects’ concern about memory problems as much as actual ones, and so far no study in HIV has actually established whether the inflammation seen in MRI scans is actually associated with neurocognitive performance.
Screening for brain impairment
The idea that some psychological tools might be reporting HIV-positive people’s fears of dementia rather than actual impairment, and might over-report neurological problems, has led London’s first dedicated HIV clinic for people over 50 at the Chelsea and Westminster Hospital to include two ten-minute psychological questionnaires for generalised anxiety disorder and depression as standard first steps in psychological assessment of patients, only proceeding to tests for neurological function once these are eliminated.

The researchers comment that “high levels of anxiety, depression and concern about cognitive function” are common in older patients and that “memory loss, mental slowing and psychomotor disorder are common manifestations of these conditions” and should therefore be assessed and treated first.   
References
Garvey L et al. Features of neurocognitive performance in over 100 neurologically-asymptomatic HIV-infected adults receiving combination antiretroviral therapy (cART). Seventeenth BHIVA Conference, Bournemouth. Abstract O5. 2011.

Ashby J et al. Cerebral function in perinatally HIV-infected young adults and their HIV-uninfected sibling controls. Seventeenth BHIVA Conference, Bournemouth. Abstract O30. 2011. 

De Silva S et al. Over 50 Clinic: how to screen for neurocognitive disorders? Seventeenth BHIVA Conference, Bournemouth. Abstract P172. 2011.

[Inchlingblue]

All I can say is that, from my own personal experience, I'm sharper than most of my HIV-negative co-workers.

My job entails a large degree of attention to detail. My co-workers cannot keep up with me. I'm not saying this to be conceited, it's just a fact.

So F*** you HIV.

[Matty the Damned]

Interesting. This means there must be another reason for why this forum has such a high concentration of bedwetters and social spastics.

MtD

[Hellraiser]

Interesting. This means there must be another reason for why this forum has such a high concentration of bedwetters and social spastics.

MtD

Spoken like a true believer.

[Matty the Damned]

Spoken like a true believer.

Need to change your sheets dear?

MtD

[tednlou2]

I just saw a news crawl today while watching MSNBC that a study said people over 50 start to loose their ability to multi-task. 

I've always wondered whether studies are thrown off, because HIV infected people are just studied more for just about everything.  If HIV neg people were studied at the same frequency and as in-depth, would we probably find more physical and mental issues with them--especially when many studies ask people how they feel or whether they feel like they can't focus and perform tasks like they use to?  I realize these studies use tests to measure cognitive function as well, which would rule out subjective answers.  But, we know people with HIV have much higher rates of depression and we know depression affects our brains' fire-power.  Do these studies take that into account?  And, taking many kinds of medication often has an effect on the brain.  I know when my mom takes her meds, she will often get all foggy and sometimes act like she's slowed down.  She will often take all her meds together--something like 7 at a time.  I've suggested she space them out.  So, are things like depression and medication factored into these studies?   

[Ann]

I keep meaning to respond to this thread, but I keep forgetting what I was gonna say.

Time to go get my sheets out of the washing machine. Ooops, TMI!

[darkerpozz]

All I can say is personally the brain fog I have gotten was so severe and my ability to multitask has diminished and that in my opinion it is easier to attribute to HIV than depression.

[Bucko]

All I can say is personally the brain fog I have gotten was so severe and my ability to multitask has diminished and that in my opinion it is easier to attribute to HIV than depression.

I seriously doubt that one can disentangle the whole depression/HIV/cognitive impairment thing, separating them all into nice little piles. But emotions have a way of confounding neat, discrete piles, and at least for me this is a very emotional issue.

The main reason why I label it an emotional issue is that I've found reason being gradually supplanted by a cloudy, hyperemotionalism as the default response to challenges and pressures of living my (admittedly complicated) life. Where before I generally felt in control and was confident of the value of the wealth of my stored, accumulated knowledge, I now find myself struggling over simple feats of memory like my phone number, for instance, or the lyrics of a song I've known for decades, often without success. These pauses cause me great consternation and provoke an emotional response that is unlikely to be reassuring on any level whatsoever.  

Perhaps the sustained high fevers I suffered in December of '02 had something to do with it; perhaps it was the absurdly melodramatic break-up of a toxic nine-year relationship that shattered me financially and emotionally; perhaps it was being rejected by my family during an especially bleak part of '07; perhaps it's a manifestation of inexplicable "bright spots" in a brain MRI that was performed in '01; perhaps it is the reality of having survived 27 years with the virus: who knows?

However, if, just before an angioplasty was performed a few years back my PCP (who specializes in HIV+ folk) was shocked at the condition of my arteries, comparing them to those of a man older than my father, then perhaps this "impairment" is just another manifestation of HIV's knack to cause one's body to age prematurely. Frankly, I don't find it any more (nor less) comforting an option than anything else.  

[elf]

All I can say is that, from my own personal experience, I'm sharper than most of my HIV-negative co-workers.

My job entails a large degree of attention to detail. My co-workers cannot keep up with me. I'm not saying this to be conceited, it's just a fact.

So F*** you HIV.

Same here.
I'm still amazed at the amount of detail I can ''collect''. 
I've just added a 5th foreign language to my ''learning'' schedule. 
Au revoir. 

PS
I do take some neuroprotective supplements, like omega-3, melatonin and low dose aspirine. 

[eric48]

All I can say is personally the brain fog I have gotten was so severe and my ability to multitask has diminished and that in my opinion it is easier to attribute to HIV than depression.

I would not know what to attribute it to.

I suffer from brain fog and my ability to multitask has diminished. That is a fact.

Before I was diagnosed I never had brain fog. I had already been infected for 8 months. Soon after diagnosis the brain fog started, therefore, I 'd be tempted to  attribute it ... diagnosis   LOL

Eric

[red_Dragon888]

I would not know what to attribute it to.

I suffer from brain fog and my ability to multitask has diminished. That is a fact.

Before I was diagnosed I never had brain fog. I had already been infected for 8 months. Soon after diagnosis the brain fog started, therefore, I 'd be tempted to  attribute it ... diagnosis   LOL

Eric

It could be food allergies, or the medication, or something in your working or living environment that is the cause for it.  I just do not think "bran fog," happens on its own.

[bocker3]

It could be food allergies, or the medication, or something in your working or living environment that is the cause for it.  I just do not think "bran fog," happens on its own.

Really??  Then how do you explain "forgetting" to respond to that post for almost 6 months??

[wolfter]

Really??  Then how do you explain "forgetting" to respond to that post for almost 6 months??

Precious!   Love the tidbits of humor that bring a smile. 

Call it what you may, but I recall a thread a while ago where a lot of us were discussing this topic.  I used the term "brain fade" for years to describe my cognitive decline.  I still experience it regularly but have adjusted to it.  Sometimes actually enjoying it.   My family and friends have noticed it for years. 

[red_Dragon888]

Well, I had "Brain Fade" once and it was severe.  Yes, I was poz at the time, about 3 to 5 years, and I was not under any HIV meds but my memory or more precisely, my short term memory was gone.  I could not remember any thought after 5 seconds.  I was amazed and frightened on how all I could remember was that I could not remember the last thought that happened a second ago.  I got home safely, with the help of my boyfriend at the time, but the condition lasted until the next morning.  I feared that maybe the HIV invaded my brain or weaken my immune system so much that it allowed an active infection on the brain barrier for I felt a tightness inside my skull.  The next morning I was fine but that night I used any treatment I could think of the combat the attack.  I forgotten the incident and thought nothing of it, but perhaps that is also a product of the attack.  You just forget what happened and it never happened.  Is this "Brain Fog or Brain Fade?"  I assume yes.

My younger brother had the same symptoms and he panic, but luckily me and my mother was there to help him.  He seemed to have gone through the same issues, but he did nothing and he was well the next morning.  Again, I forgot the incident.  Wow!!!

Maybe we did not have BF but that is the name I gave it.  I did not mean to minimize BF, but to get info.  Sorry if I'd ruffled some feathers.

Dragon

[TheRoof]

I would not know what to attribute it to.

I suffer from brain fog and my ability to multitask has diminished. That is a fact.

Before I was diagnosed I never had brain fog. I had already been infected for 8 months. Soon after diagnosis the brain fog started, therefore, I 'd be tempted to  attribute it ... diagnosis   LOL

Eric

Same here, I was perfectly fine the first 6 months after being diagnosed with HIV. (at that point I had for 7-8 months) After around 6 months I started noticing problems such as Brain Fog. I didn't suffer from depression at the time, in fact I was actually in good spirits. It just kind of came by itself.

I had stress before, but I never had brain fog like after being diagnosed with HIV. Sometimes it's unbearable.

[TonyDewitt]

I hope that everyone's brain fog resolves - I'm encouraged by Inchlingblue & Elf's comments that they continue to use their brains productively. Regardless of our situations, we all need a functioning brain to survive, so I'm hoping that Inchlingblue will continue to outperform his coworkers and and Elf will be learning more languages.