title: Real-world impact of neurocognitive deficits in acute and early HIV infection.
abstract: The acute and early period of HIV-1 infection (AEH) is characterized by neuroinflammatory and immunopathogenic processes that can alter the integrity of neural systems and neurocognitive functions. However, the extent to which central nervous system changes in AEH confer increased risk of real-world functioning (RWF) problems is not known. In the present study, 34 individuals with AEH and 39 seronegative comparison participants completed standardized neuromedical, psychiatric, and neurocognitive research evaluations, alongside a comprehensive assessment of RWF that included cognitive symptoms in daily life, basic and instrumental activities of daily living, clinician-rated global functioning, and employment. Results showed that AEH was associated with a significantly increased risk of dependence in RWF, which was particularly elevated among AEH persons with global neurocognitive impairment (NCI). Among those with AEH, NCI (i.e., deficits in learning and information processing speed), mood disorders (i.e., Bipolar Disorder), and substance dependence (e.g., methamphetamine dependence) were all independently predictive of RWF dependence. Findings suggest that neurocognitively impaired individuals with AEH are at notably elevated risk of clinically significant challenges in normal daily functioning. Screening for neurocognitive, mood, and substance use disorders in AEH may facilitate identification of individuals at high risk of functional dependence who may benefit from psychological and medical strategies to manage their neuropsychiatric conditions.
authors.affiliation: Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego, CA, USA.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Doyle
authors.forename: Erin E
authors.initials: EE
authors.lastname: Morgan
authors.forename: Sheldon
authors.initials: S
authors.lastname: Morris
authors.forename: Davey M
authors.initials: DM
authors.lastname: Smith
authors.forename: Susan
authors.initials: S
authors.lastname: Little
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Iudicello
authors.forename: Kaitlin
authors.initials: K
authors.lastname: Blackstone
authors.forename: David J
authors.initials: DJ
authors.lastname: Moore
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
authors.forename: Scott L
authors.initials: SL
authors.lastname: Letendre
authors.forename: Steven Paul
authors.initials: SP
authors.lastname: Woods
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000328:Adult; D000339:Affect; D000367:Age Factors; D016022:Case-Control Studies; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology* / Q000821:virology; D004651:Employment; D056344:Executive Function; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D009043:Motor Activity; D009483:Neuropsychological Tests; D012107:Research Design; D019966:Substance-Related Disorders / Q000209:etiology / Q000523:psychology* / Q000821:virology; D013997:Time Factors