1. Differences between HIV-infected adults since childhood and non HIV-infected persons on managing everyday life
“Dr. V. Babes”
Clinical Hospital
The 8th National HIV/AIDS Congress & 3rd Central European HIV Forum, 5th-7th May 2016, Sibiu, Romania
Anca Elena Luca1, Florin Lazar2, Adrian Luca3, Roxana Radoi1, Adina Talnariu1, Silvia Suciu1, Cristian Achim4, Luminita Ene1
1 “Dr. Victor Babes” Hospital for Infectious and Tropical Diseases, Bucharest, Romania 2 Faculty of Sociology and Social Work, University of Bucharest, Bucharest, Romania 3 Faculty of Psychology and Education Sciences, University of Bucharest, Bucharest, Romania 4 HIV Neurobehavioral Research Center, University of California, San Diego
Background:
Results
Mhiv+=0.47, Mhiv-=0.23, Meandif=0.24, t=3.82, CI95%(0.14, 0.32), d-Cohen=0.45 (peste medie)
HIV+ people have more cognitive difficulties than HIV- people, especially in executive functioning, working memory, learning abilities, memory delay, motor functioning, speed of information processing areas (moderate effect size d=( )
The most affected area is working memory (d=0.36)
The Romanian Pediatric Parenterally Infected Children is a cohort of children parenterally infected with HIV in the early ‘90s, who are currently
with over 25 years chronic HIV infection
exposed for 15 years to cART
have similar genetic background
This group transitioned to adulthood and experienced challenges in cognitive, social, professional and emotional life
The study aimed to investigate the long-term neurocognitive consequences of living with HIV+ in this group of young adults infected parenterally in childhood compared to an age-matched control group.
TABLE 1
Demographics
HIV +
HIV - No
234 53
Gender
Male
112 (47.9 %)
29 (54.7 %)
Female
122 (52.1 %)
24 (45.3 %)
Age (mean age)
24.17
SD=1.26
24.28
SD=2.42
Employment*
Yes
80 (35.1 %)
34 (64.2 %)
No job
148 (64.9 %)
19 (35.8 %)
Education**
8 grades 37 4
9-12 grades
105 18
> 12 grades 90 31
Methods
234 HIV+ and 53 HIV- young adults have undergone extensive neurocognitive testing ( ) using a standardized battery assessing cognitive performance in 7 domains with a composite global deficit score (GDS)
7 cognitive domains: speed of information processing, attention/working memory, executive functions, learning, memory, verbal fluency, motor
GDS < 0.5 – normal/ non-impairment, GDS ≤ impairment
* χ²<0.001, Fisher’s exact test = 15.01
** Mhiv+ =12.06, Mhiv- = 13.36, Mean diff=1.29, t=-3.06, CI95% (-2.12,-0.46) d-Cohen=0.36 (minor effect size)
Mhiv+=6.17, Mhiv-=4.08, Mdif=2.09, t=2.77, sig=0.024, CI95%(0.54, 3.53), d=0.24.
Depressive symptoms are more frequent in HIV+ population, but with minor effect size.
Education Parents’ background is the same for both groups. Even so, HIV+ people are less educated than HIV- adults.
Discussions
Patients’ functioning was assessed using two Self-report Questionnaires:
1. Activities of daily living (ADL) – reports the level of performing basic tasks of everyday life like housekeeping, ability to handle finances, shopping, cooking, laundry, ability to use telephones, bathing, dressing, etc.
2. Patient’s Assessment of Own Functioning Inventory (PAOFI) - a subjective neurocognitive complaint questionnaire where patients rated their problems with memory, language and communication, sensory-motor skills, and higher level cognitive and intellectual functions
Depressive symptoms were assessed with Beck Depression Inventory (BDI≥13 is depression)
We compared HIV+ with HIV- patients in terms of cognitive performance imp/nonimp (GDS), depression (BDI), self-perceived functioning (ADL), cognitive complaints (PAOFI), level of education, parent’s education, employment status and incomes.
Young adults with chronic HIV infection compared to HIV uninfected matched controls had
higher rates of neurocognitive impairment, a trend for more depressive symptoms, lower employment rates.
HIV+ adults had similar levels of self-perceived functioning and cognitive complaints
compared to the control group
Having similar levels of self-perceived functioning and cognitive complains suggest a coping
mechanism developed by HIV+ participants to face the everyday challenges of living with the infection.
64.2% HIV– adults are employed, while 64.9% of HIV+ adults have no job.
The income in the HIV+ employed population was less than in the HIV- employed ones, but the difference is not significant.
In everyday functioning both HIV+ and HIV- participants are performing the same. HIV+ adults declared an actual decline in their activities of daily living functioning than in the past. t=3.267, Mnow=2.67, Mbest/past=2.41, CI95% (0.106, 0.422), p<0.001
At PAOFI HIV+ participants reported more cognitive complains, but effect size is minor (d=0.167).
Both groups enjoy social interactions equally.
Acknowledgements
All study participants
In memoriam Dr. Dan Duiculescu
HIV Neurobehavioral Research Center at UCSD team: Dr. Thomas Marcotte, Dr. Ronald Ellis, Psy Terence Hendrix
Casa Doru staff: Dr. Cristiana Oprea, Dr. Simona Tetradov, Dr. Ruxandra Burlacu
To all our collaborators in the country (doctors and psychologists from INBI Matei Bals, Brasov, Constanta, Timisoara, Craiova, Cluj, Targu-Mures, Iasi)
This study was funded by NIH grant R01MH “Long term effects of chronic HIV infection on the developing brain”