scholarly journals Development of a Nomogram-Based Tool to Predict Neurocognitive Impairment Among HIV-positive Charter Participants

2021 ◽  
Vol 15 (1) ◽  
pp. 52-62
Author(s):  
Zaeema Naveed ◽  
Howard S. Fox ◽  
Christopher S. Wichman ◽  
Pamela May ◽  
Christine M. Arcari ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Neurocognitive Impairment ◽  
Calibration Plot ◽  
People Living With Hiv ◽  
Clinical Settings ◽  
Predictive Tool ◽  
Neurocognitive Assessment ◽  
Predicted Probability ◽  
User Friendly ◽  
Living With Hiv

Background: Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH). Studies have generated inconsistent results regarding etiological factors for NCI in PLWH. Furthermore, a user-friendly and readily available predictive tool is desirable in clinical practice to screen PLWH for NCI. Objective: This study aimed to identify factors associated with NCI using a large and diverse sample of PLWH and build a nomogram based on demographic, clinical, and behavioral variables. Methods: We performed Bayesian network analysis using a supervised learning technique with the Markov Blanket (MB) algorithm. Logistic regression was also conducted to obtain the adjusted regression coefficients to construct the nomogram. Results: Among 1,307 participants, 21.6% were neurocognitively impaired. During the MB analysis, age provided the highest amount of mutual information (0.0333). Logistic regression also showed that old age (>50 vs. ≤50 years) had the strongest association (OR=2.77, 95% CI=1.99-3.85) with NCI. The highest possible points on the nomogram were 626, translated to a nomogram-predicted probability of NCI to be approximately 0.95. The receiver operating characteristic (ROC) curve's concordance index was 0.75, and the nomogram's calibration plot exhibited an excellent agreement between observed and predicted probabilities. Conclusion: The nomogram used variables that can be easily measured in clinical settings and, thus, easy to implement within a clinic or web-interface platform. The nomogram may help clinicians screen for patients with a high probability of having NCI and thus needing a comprehensive neurocognitive assessment for early diagnosis and appropriate management.

HIV‐associated neurocognitive impairment in stable people living with HIV on ART in rural Tanzania

HIV Medicine ◽  
2020 ◽  
Author(s):  
M Sanmartí ◽  
AC Meyer ◽  
A Jaen ◽  
K Robertson ◽  
N Tan ◽  
...  
Keyword(s):  
Neurocognitive Impairment ◽  
People Living With Hiv ◽  
Rural Tanzania ◽  
Living With Hiv

scholarly journals Psycho-behavioral factors associated with neurocognitive performance among people living with HIV on antiretroviral therapy in Accra, Ghana

2020 ◽  
Vol 20 (2) ◽  
pp. 587-596
Author(s):  
Nana Asiedu ◽  
Irene Kretchy ◽  
Emmanuel Asampong
Keyword(s):  
Operating Characteristic ◽  
Neurocognitive Impairment ◽  
People Living With Hiv ◽  
Neurocognitive Performance ◽  
Factors Associated ◽  
Non Invasive ◽  
Hiv Management ◽  
Behavioural Factors ◽  
Living With Hiv ◽  
Selection Of

Background: It is estimated that almost half of all people living with HIV have some form of neurocognitive impairment, but few studies have looked at the risk of neurocognitive impairment and its associated factors in Ghana, due in part to limited resources for such testing. Objective: To examine neurocognitive performance in a group of Ghanaians living with HIV and possible factors that contribute to their performance. Methods: One hundred and four patients were assessed using a selection of brief non-invasive neuropsychological assess- ments as well as the International HIV Dementia Scale. Psycho-behavioural factors (alcohol use, depression, and medication adherence) as well as demographic characteristics and functional daily activities were assessed to determine their association with neurocognitive performance, using linear regression and receiver operating characteristic analyses. Results: About 48% of the participants met the criteria for risk of neurocognitive impairment. Age, education, and symp- toms of depression were found to be significantly associated with the risk of impairment. Conclusion: Some people living with HIV showed risk of neurocognitive impairment, which was significantly associated with education, age and depressive symptoms. It is therefore important to consider routine neurocognitive screening in HIV management to recognize any risks for early interventions. Keywords: ART adherence; depression; neurologic disease.

Implementation of HIV Prevention Interventions with People Living with HIV/AIDS in Clinical Settings: Challenges and Lessons Learned

2007 ◽  
Vol 11 (S1) ◽  
pp. 17-29 ◽  
Author(s):  
Kimberly A. Koester ◽  
Andre Maiorana ◽  
Karen Vernon ◽  
Janet Myers ◽  
Carol Dawson Rose ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Lessons Learned ◽  
People Living With Hiv ◽  
Clinical Settings ◽  
Prevention Interventions ◽  
Hiv Prevention Interventions ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals Antiretroviral therapy improves neurocognitive impairment in people living with HIV? A meta-analysis

2020 ◽  
Vol 7 (2) ◽  
pp. 238-247 ◽  
Author(s):  
Chang Gao ◽  
Jingjing Meng ◽  
Xueling Xiao ◽  
Min Wang ◽  
Ann Barterley Williams ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Meta Analysis ◽  
Neurocognitive Impairment ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals 352. Characteristics Associated with Pre-Frailty in Older People Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S186-S186
Author(s):  
Peter Mazonson ◽  
Theoren Loo ◽  
Jeff Berko ◽  
Sarah-Marie Chan ◽  
Ryan Westergaard ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cognitive Function ◽  
Older People ◽  
Logistic Regression Analysis ◽  
The United States ◽  
People Living With Hiv ◽  
Factors Associated ◽  
Increased Risk ◽  
Living With Hiv

Abstract Background Frailty is a concern among older people living with HIV (PLHIV). There is a paucity of research characterizing PLHIV who are at risk of becoming frail (pre-frailty). To investigate how HIV impacts older PLHIV in the United States, a new study called Aging with Dignity, Health, Optimism and Community (ADHOC) was launched at ten sites to collect self-reported data. This analysis uses data from ADHOC to identify factors associated with pre-frailty. Methods Pre-frailty was assessed using the Frailty Index for Elders (FIFE), where a score of zero indicated no frailty, 1–3 indicated pre-frailty, and 4–10 indicated frailty. A cross-sectional analysis was performed on 262 PLHIV (age 50+) to determine the association between pre-frailty and self-reported sociodemographic, health, and clinical indicators using bivariate analyses. Factors associated with pre-frailty were then included in a logistic regression analysis using backward selection. Results The average age of ADHOC participants was 59 years. Eighty-two percent were male, 66% were gay or lesbian, and 56% were white. Forty-seven percent were classified with pre-frailty, 26% with frailty, and 27% with no frailty. In bivariate analyses, pre-frailty was associated with depression, low cognitive function, depression, multiple comorbidities, low income, low social support and unemployment (Table 1). In the multiple logistic regression analysis, pre-frailty was associated with having low cognitive function (Odds Ratio [OR] 8.56, 95% Confidence Interval [CI]: 3.24–22.63), 4 or more comorbid conditions (OR 4.00, 95% CI: 2.23–7.06), and an income less than $50,000 (OR 2.70, 95% CI: 1.56–4.68) (Table 2). Conclusion This study shows that commonly collected clinical and sociodemographic metrics can help identify PLWH who are more likely to have pre-frailty. Early recognition of factors associated with pre-frailty among PLHIV may help to prevent progression to frailty. Understanding markers of increased risk for pre-frailty may help clinicians and health systems better target multi-modal interventions to prevent negative health outcomes associated with frailty. Disclosures All authors: No reported disclosures.

scholarly journals Impact of Isoniazid Preventive Therapy on Tuberculosis incidence among people living with HIV: A secondary data analysis using Inverse Probability Weighting of individuals attending HIV care and treatment clinics in Tanzania

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254082
Author(s):  
Werner M. Maokola ◽  
Bernard J. Ngowi ◽  
Michael J. Mahande ◽  
Jim Todd ◽  
Masanja Robert ◽  
...  
Keyword(s):  
Observational Studies ◽  
Cox Regression ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Clinical Settings ◽  
Inverse Probability ◽  
Care And Treatment ◽  
Living With Hiv

Background Information on how well Isoniazid Preventive Therapy (IPT) works on reducing TB incidence among people living with HIV (PLHIV) in routine settings using robust statistical methods to establish causality in observational studies is scarce. Objectives To evaluate the effectiveness of IPT in routine clinical settings by comparing TB incidence between IPT and non-IPT groups. Methods We used data from PLHIV enrolled in 315 HIV care and treatment clinic from January 2012 to December 2016. We used Inverse Probability of Treatment Weighting to adjust for the probability of receiving IPT; balancing the baseline covariates between IPT and non-IPT groups. The effectiveness of IPT on TB incidence was estimated using Cox regression using the weighted sample. Results Of 171,743 PLHIV enrolled in the clinics over the five years, 10,326 (6.01%) were excluded leaving 161,417 available for the analysis. Of the 24,800 who received IPT, 1.00% developed TB disease whereas of the 136,617 who never received IPT 6,085 (4.98%) developed TB disease. In 278,545.90 person-years of follow up, a total 7,052 new TB cases were diagnosed. Using the weighted sample, the overall TB incidence was 11.57 (95% CI: 11.09–12.07) per 1,000 person-years. The TB incidence among PLHIV who received IPT was 10.49 (95% CI: 9.11–12.15) per 1,000 person-years and 12.00 (95% CI: 11.69–12.33) per 1,000 person-years in those who never received IPT. After adjusting for other covariates there was 52% lower risk of developing TB disease among those who received IPT compared to those who never received IPT: aHR = 0.48 (95% CI: 0.40–0.58, P<0.001). Conclusion IPT reduced TB incidence by 52% in PLHIV attending routine CTC in Tanzania. IPTW adjusted the groups for imbalances in the covariates associated with receiving IPT to achieve comparable groups of IPT and non-IPT. This study has added evidence on the effectiveness of IPT in routine clinical settings and on the use of IPTW to determine impact of interventions in observational studies.

scholarly journals Metabolic Risk Factors as Differential Predictors of Profiles of Neurocognitive Impairment Among Older HIV+ and HIV− Adults: An Observational Study

2019 ◽  
Author(s):  
Elizabeth C Pasipanodya ◽  
Jessica L Montoya ◽  
Laura M Campbell ◽  
Mariam A Hussain ◽  
Rowan Saloner ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Probability ◽  
Latent Class ◽  
Neurocognitive Impairment ◽  
Metabolic Risk Factors ◽  
People Living With Hiv ◽  
Significant Heterogeneity ◽  
Metabolic Risk ◽  
Multinomial Regression ◽  
Living With Hiv

Abstract Objective Neurocognitive performance among older persons, including those living with HIV (people living with HIV [PLWH]), exhibits significant heterogeneity, suggesting subpopulations with differing profiles of neurocognitive impairment (NCI). Metabolic factors are associated with NCI, but their relationships to cluster-derived NCI profiles are unknown. Method Participants (144 PLWH and 102 HIV uninfected) aged 50+ years completed a neuropsychological battery assessing seven cognitive domains. Latent class analysis (LCA) identified NCI profiles separately by HIV serostatus and in a combined sample. Obtained classes were examined against the Montreal Cognitive Assessment (MoCA) and diagnoses of HIV-associated neurocognitive disorders (HAND). Multinomial regression identified metabolic predictors of classification. Results LCA identified three latent classes in each participant sample: Class1Multidomain NCI (high probability of impairment across multiple domains), Class 2Learning & Recall NCI (high probability of impairment in learning and recall), and Class 3NC Unimpaired (low probability of NCI across all domains). Severity of NCI implied by classes corresponded with MoCA scores and HAND diagnoses. In analyses on the combined sample, compared to HIV-uninfected individuals, PLWH were more likely to be in Class1Multidomain NCI. Among PLWH, those with dyslipidemia and hypertension had greater odds of classification in Class 1Multidomain NCI while those with central obesity had higher odds of classification in Class 2Learning & Recall NCI; metabolic syndrome approached significance as a differential predictor. Regardless of HIV status, individuals with diabetes were more likely to be in Class 1Multidomain NCI. Conclusions Metabolic risk factors confer heightened risk of NCI in HIV infection. Interventions to reduce metabolic risk may improve neurocognitive outcomes among PLWH.

scholarly journals Benzodiazepine Use Is Associated With an Increased Risk of Neurocognitive Impairment in People Living With HIV

2019 ◽  
Vol 82 (5) ◽  
pp. 475-482 ◽  
Author(s):  
Rowan Saloner ◽  
David J. Grelotti ◽  
Griffin Tyree ◽  
Erin E. Sundermann ◽  
Qing Ma ◽  
...  
Keyword(s):  
Neurocognitive Impairment ◽  
People Living With Hiv ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Living With Hiv

scholarly journals Psychological Distress and Its Correlates among Newly Diagnosed People Living with HIV in Northwest Ethiopia: Ordinal Logistic Regression Analyses

2021 ◽  
Vol 14 ◽  
pp. 117863372199459
Author(s):  
Nurilign Abebe Moges ◽  
Olubukola Adeponle Adesina ◽  
Micheal A Okunlola ◽  
Yemane Berhane ◽  
Joshua Odunayo Akinyemi
Keyword(s):  
Logistic Regression ◽  
Psychological Distress ◽  
Alcohol Use ◽  
Health Centers ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Regression Analyses ◽  
Sexually Transmitted ◽  
History Of ◽  
Living With Hiv

Background: Although there is a high burden of HIV in sub-Saharan Africa (SSA), studies on mental health issues among people living with HIV are scarce. The study addressed the transition to “test and treat” guidelines for HIV, which makes it unique regarding its evaluation of psychological distress amongst newly initiated people living with HIV in the test and treat era. Methods: We conducted a cross-sectional survey of 689 people newly diagnosed with HIV. Symptoms of psychological distress were measured using the Kessler-10 psychological distress assessment scale. Factors associated with psychological distress were captured using interviewer-administered questionnaires. Ordinal logistic regression analyses were employed to identify predictors of psychological distress. Results: The magnitude of psychological distress was 58.63% (95% CI = 55.2%-62.3%). The severity of the psychological distress of which, 17.42% had severe distress. Psychological distress was observed more among female patients (β = 0.47, AOR = 1.59, 95% CI = 1.12, 2.27), patients presented with opportunistic infections (β = 0.50, AOR = 1.65, 95% CI = 1.03, 2.66) and being non-working functional status (β = 0.99, AOR = 2.70, 95% CI = 1.64, 4.45). Moreover, patients who were malnourished (β = 0.46, AOR = 1.58, 95% CI = 1.09, 2.26), having good level of knowledge on HIV prevention (β = 0.59, 95% CI = 0.55, 0.39, 0.78), presented with sexually transmitted infection (β = 0.48, AOR = 1.61, 95% CI = 1.01, 2.58), history of alcohol use (β = 0.44, AOR = 1.55, 95% CI = 1.09, 2.21), perceived stigma (β = 0.08, AOR = 1.09 95% CI = 1.04, 1.15) and treated in health centers (β = 0.55, AOR = 1.74, 95% CI = 1.25, 2.41) had higher odds of psychological distress. Conclusion: The large majority of newly diagnosed HIV patients suffered from psychological distress. An increased vulnerability was observed among females, those with opportunistic and sexually transmitted infections, those having poor functional status and malnourished. Furthermore, HIV patients treated in health centers, those who had history of alcohol use and patients with high level of HIV related stigma are more negatively affected by the HIV diagnosis. Hence, all intervention strategies should target all the identified predictors.

scholarly journals The Role of Mental Health Conditions in the Diagnosis of Neurocognitive Impairment in People Living with HIV

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 543
Author(s):  
Irene Portilla-Tamarit ◽  
Nicolás Ruiz-Robledillo ◽  
Marcos Díez-Martínez ◽  
Rosario Ferrer-Cascales ◽  
Cristian Alcocer-Bruno ◽  
...  
Keyword(s):  
Mental Health ◽  
Antiretroviral Treatment ◽  
Neurocognitive Impairment ◽  
Health Condition ◽  
Health Conditions ◽  
People Living With Hiv ◽  
Mental Health Condition ◽  
Hiv Viral Load ◽  
Mental Health Conditions ◽  
Living With Hiv

The aims of the present study were to evaluate the prevalence of undiagnosed mental health conditions (UMHC) in people living with HIV (PLWHIV) on antiretroviral treatment and with long-term suppressed HIV viremia, and its association with neurocognitive impairment (NCI). A cross-sectional observational study on HIV subjects, ≥18 years old, on stable antiretroviral treatment and with HIV viral load <50 copies/mL was carried out. Patients with known comorbidities, substances abuse, anxiety or depression were excluded. UMHC were evaluated by the Millon Clinical Multiaxial Inventory-III and NCI by Frascati criteria. The association between NCI and sociodemographic, clinical HIV variables and mental health conditions was analyzed. Further, the relationship between mental health conditions scores and NCI diagnosis was evaluated. Eighty patients were included, 37.5% had at least one undiagnosed mental health condition, and 26.3% had NCI. The most frequent mental health conditions were: anxiety (21.3%); bipolar disorder (11.3%); and substance dependence (8.8%). Only longer time since HIV diagnosis (p = 0.030) and at least one mental health condition diagnosis (p = 0.002) showed an association with NCI. Participants with NCI presented higher scores in anxiety, alcohol dependence and post-traumatic stress. Undiagnosed mental health conditions are frequent in PLWHIV. These disorders cannot be identified by HIV clinicians or basic screening questionnaires, and they are not usually self-reported by patients. UMHC could act as confounders in the evaluation of NCI.

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