Publication Abstract Display
Type: Published Abstract
Title: Older HIV-infected Hispanics are at increased risk for neurocognitive impairment.
Authors: Marquine M, Moore DJ, Byrd D, Rivera-Mindt M, Cherner M, Jeste D, Ellis R, Letendre SL, Heaton RK
Year: 2015
Publication: HIV & Aging Conference
Volume: Issue: Pages:
Abstract:Background: Hispanics are disproportionally affected by HIV/AIDS, especially in the older age ranges. Despite availability of more effective antiretroviral therapy (ART), HIV-associated neurocognitive (NC) impairment remains common. The limited data available indicate that HIV-infected (HIV+) Hispanics are at increased risk for NC impairment compared to HIV+ non-Hispanic Whites, particularly among older cohorts. Yet, Hispanics are a very heterogeneous group, and prior work has focused on HIV+ older Hispanics living in the northeastern United States (U.S.), who were primarily of Caribbean descent. The purpose of the present study was to investigate ethnic differences in NC function between older HIV+ non-Hispanic Whites and Hispanics of primarily Mexican descent. Materials & Methods: HIV+ English-speaking adults aged 50 or older, who participated in cohort studies at the UC San Diego HIV Neurobehavioral Research Program were included in the present study (years of age: M=57.7, SD=6.2; years of education: M=13.1, SD=2.3; 95% male; 83% AIDS; 94% on ART; current CD4: Median=489, IQR=325-682; 17% with detectable plasma HIV RNA). Participants included 20 individuals who self-identified as Hispanic, and 40 non-Hispanic Whites, who were matched two-to-one to Hispanics on age, gender and years of education. NC function was assessed via the NIH-Toolbox Cognition Battery (NIH-TB CB), which has extensive normative data for Hispanics and non-Hispanic Whites. Possible covariates that were considered included estimates of quality of education/premorbid functioning (NIH-TB CB Oral Reading), HIV disease characteristics (estimated duration of infection, AIDS status, nadir and current CD4, ART status, and detectable HIV RNA in plasma and CSF), and psychiatric comorbidities (current mood, and current and lifetime history of major depressive and substance use disorders). To investigate ethnic group differences in NC performance, we conducted two types of analyses on the NIH-TB CB Fluid composite T-scores and the individual test scores comprising this composite. Initially, we contrasted ethnic groups via a series of separate independent sample t-tests. We then conducted linear regression models adjusting for covariates that differed between the groups (p<.10). Results: Results from independent sample t-tests showed that Hispanics performed significantly worse on the Fluid composite (Mean T=40.2, SD=10.0) than non-Hispanic Whites (Mean T=49.2, SD=10.1, p<.01). Analyses on individual tests indicated Hispanics scored significantly lower on the Flanker Inhibitory Control and Attention test (Hispanics: Mean T=38.3, SD=14.8; non-Hispanic Whites: Mean T=50.7, SD=10.6, p<.01), Pattern Comparison (Hispanics: Mean T =43.06, SD=10.8; non-Hispanic Whites: Mean T=50.9, SD=12.5, p=.02), and Picture Sequence Memory test (Hispanics: Mean T=41.4, SD=5.4; non-Hispanic Whites: Mean T=46.1, SD=9.2, p=.02). Results from multivariable models adjusting for significant covariates (i.e. oral reading and lifetime substance use disorder) yielded similar findings. Conclusions: Older HIV-infected Hispanics may be particularly vulnerable to NC impairment compared to their non-Hispanic White counterparts. These ethnic differences do not appear to be driven by lower quality of education or premorbid functioning, worse HIV disease characteristics, or psychiatric comorbidities. Future studies aimed at identifying biomedical and psychosocial factors driving these ethnic differences are key for the development of targeted, culturally-relevant interventions to prevent and/or ameliorate NC dysfunction in this vulnerable segment of the HIV+ U.S. population.

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