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. 2017 Oct;23(5):725-733.
doi: 10.1007/s13365-017-0557-5. Epub 2017 Sep 11.

Effort and neuropsychological performance in HIV-infected individuals on stable combination antiretroviral therapy

Robert Paul  1   2 , Gina Rhee  3 , Laurie M Baker  1   2 , Florin Vaida  4 , Sarah A Cooley  3 , Beau M Ances  5   6
Affiliations

Effort and neuropsychological performance in HIV-infected individuals on stable combination antiretroviral therapy

Robert Paul et al. J Neurovirol. 2017 Oct.

Abstract

The expression of cognitive symptoms associated with HIV varies over time and across individuals. This pattern may reflect transient contextual factors, including the degree of effort exerted by individuals undergoing cognitive testing. The present study examined whether effort corresponds to the expression of persistent HIV-related cognitive impairment among individuals receiving combination antiretroviral therapy (cART). HIV+ individuals (n = 111) averaged 48.2 (14.9) years of age and 13.0 (2.7) years of education and HIV- individuals (n = 92) averaged 34.9 (17.2) years of age and 13.5 (1.9) years of education. Participants completed a neuropsychological battery and a clinically validated measure of effort (Test of Memory Malingering, trial 1). Results revealed that the vast majority of HIV+ (85%) and HIV- (89%) individuals performed above published guidelines for adequate effort. Furthermore, the expression of cognitive impairment in HIV was not related to effort performance. The results were unchanged when examining HIV+ individuals with and without viral suppression. Finally, disability and disability-seeking status, and a proxy measure of apathy did not correspond to effort levels in HIV+ individuals. These findings suggest that variability in the expression of cognitive impairment in the cART era is unlikely to represent overt effort failures or other confounds unrelated to the disease. Persistent cognitive impairment in HIV likely represents historical and/or ongoing disease mechanisms despite otherwise successful treatment.

Keywords: Cognition; Effort; HIV; Neuropsychological performance; Test of Memory Malingering (TOMM).

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Figures

Figure 1
Figure 1
Raw TOMM T1 score for HIV− individuals, cognitively normal HIV+ individuals, and cognitively impaired HIV+ individuals. Cognitive impairment was defined as a Z-score < −1.0 in two or more cognitive domains, or a Z-score of < −2.0 in at least cognitive domain. No significant differences existed between the three groups.
Figure 2
Figure 2
Relationship between TOMM T1 and NPZ-Global in HIV+ Individuals. A majority of HIV+ participants provided optimal effort. No significant relationship was seen between cognition and effort for HIV+ individual
See this image and copyright information in PMC

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