| Publication Abstract Display | | Type: Published Abstract | | Title: Racial/ethnic differences in neurocognitive performance among adults living with HIV. | | Authors: Watson C, Marquine M, Moore R, Heaton A, Perez-Tejada A, Umlauf A, Morgan E, Hussain M, Cherner M, Ellis R, Grant I, Heaton R | | Year: 2017 | | Publication: 125th Convention for the American Psychological Association | | Volume: Issue: Pages: | | Abstract:Introduction: HIV/AIDS disproportionately affects Blacks/African-Americans and Hispanics/Latinos in the United States (US), and these are the two largest racial/ethnic minority groups in the country. Despite availability of effective antiretroviral therapy (ART) for the management of HIV disease, HIV-associated neurocognitive impairment (NCI) remains common. Recent findings suggest that HIV-infected (HIV+) Latinos are at increased risk for NCI compared to HIV+ non-Latino Whites, and there is mixed evidence that HIV+ African-Americans may have increased NCI risk compared to non-Latino Whites. The purpose of this study was to: (1) investigate HIV-associated neurocognitive performance across the three major racial/ethnic groups in the US utilizing the NIH-Toolbox Cognition Battery (NIH-TB CB); and (2) determine key predictors of neurocognitive performance by racial/ethnic group.
Methods: Participants included 415 English-speaking HIV+ adults (84 non-Latino African-American, 79 Latino, 252 non-Latino White) assessed at the UC San Diego HIV Neurobehavioral Research Program. The study sample was 88.9% men, and averaged 51.1 (± 11.7) years of age and 13.9 (± 2.5) years of education; 61.5% of the sample had received an AIDS diagnosis, 92.9% were on ART, and among those on ART, 12.7% had detectable plasma HIV RNA values. Neurocognitive function was assessed via Fluid Composite T-Scores of the NIH-TB CB with normative corrections for age, education, gender, race, and ethnicity. Participants also completed comprehensive psychiatric and neuromedical evaluations, assessing psychiatric comorbidities, HIV disease characteristics, and the Veterans Aging Cohort Study (VACS) Index, which is a composite marker of physical health among HIV+ individuals.
Results: An analysis of variance (ANOVA) on Fluid Cognition Composite T-scores showed no significant overall group differences when comparing the three ethnic/racial groups (African Americans: M=47.19, SD=12.07; Whites: M=47.43, SD=10.81; Latinos: M=44.50, SD=10.55; p=.11). A series of ANOVAs (with follow-up pairwise comparisons with Tukey’s corrections) on individual tests comprising the Fluid Cognition Composite, showed that Whites performed significantly higher than Latinos on tests of episodic memory (Picture Sequence Memory Test; p<.0001, Cohen’s d=.57) and working memory (List Sorting Working Memory Test; p=.0283, Cohen’s d=.34); and both African-Americans and Whites performed significantly higher than Latinos on a test of inhibitory control and attention (Flanker Inhibition Control and Attention Test; p=.0082 and .0410, Cohen’s d =.44 and .31, for comparisons with African-Americans and Whites, respectively). There were no significant differences between African-Americans and Whites on any of the individual tests.
Results from stratified stepwise regression analyses by racial/ethnic group revealed the following predictors of worse neurocognitive performance by group: among Whites, significant predictors were CNS penetration effectiveness and current substance use disorder (ps<.01); among African-Americans, lifetime diagnosis of major depressive disorder was the only significant predictor (p<.01); and among Latinos, the sole significant predictor was lower nadir CD4 (p=.02).
Discussion: Findings from the NIH TB CB suggest that HIV+ Latinos may be at increased risk of NCI compared to HIV+ Whites and African-Americans. Some key correlates of neurocognitive function differ across racial/ethnic groups. Consideration of these HIV disease characteristics and comorbidities may be valuable in addressing disparities in HIV-associated NCI among underserved racial/ethnic groups in the US. Future studies combining these factors with economic, socio-environmental, and other culturally-relevant biomedical factors may guide development of targeted interventions to reduce these disparities. |
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