Abstract
Human immunodeficiency virus (HIV)–associated cognitive impairment, a significant cause of morbidity, affects up to 30% of HIV-infected people. Its prevalence doubled as patients began to live longer after the introduction of highly active retroviral therapy. Women are now one of the fastest growing groups with acquired immunodeficiency syndrome (AIDS) in the United States and Puerto Rico, but relatively little is known about the prevalence and characteristics of cognitive dysfunction in HIV-infected women. In this study the authors investigated its prevalence in a group of HIV-1–seropositive Hispanic women in Puerto Rico. Forty-nine women with a nadir CD4 cell count of ≤ 500 cells/mm3 were enrolled. Cognitive impairment was defined according to the American Academy of Neurology criteria for HIV dementia as modified to identify an “asymptomatic cognitively impaired” group. Observed prevalence was compared with prevalence in other populations in United States, Europe, and Australia. Differences in clinical markers and neuropsychological test performance among the cohort stratified by cognitive impairment were tested. Cognitive impairment was observed in 77.6% (38/49) of cases; asymptomatic cognitive impairment in 32.7% (16/49); minor cognitive motor disorders in 16.3% (8/49); and HIV-associated dementia (HAD) in 28.6% (14/49). Cognitive impairment did not correlate with age, CD4 cell count, viral load, or treatment modality. The cross-sectional prevalence of HIV-associated cognitive impairment was 77.6% (28.6% for HAD). These findings should enhance awareness of the prevalence of HIV-associated cognitive impairment, both clinically apparent and “asymptomatic,” in Hispanic women and lead to improvements in areas such as education and compliance and to reevaluation of treatment interventions.
This work was supported in part by S11NS046278-01A1, U54 NS43011, NS049465, RCRII 1P20RR11126, and UPR Health Services Research Center, grants 5S21MD00242 and 5S21MD00138 from the National Center for Minority Health and Health Disparities.
The authors gratefully acknowledge the women, HIV positive and seronegative, who participated in this study and the personnel of the University of Puerto Rico Medical Sciences Campus Clinical Research Center, where the evaluation of the participants took place.