Posttraumatic Stress Disorder and Neurocognitive Impairment in a U.S. Military Cohort of Persons Living with HIV

Abstract

Objective: Neurocognitive impairment (NCI) is a well-known complication of human immunodeficiency virus (HIV) infection and may be influenced by a number of psychological factors. We examined the relationship between NCI and mental health disorders, including posttraumatic stress disorder (PTSD), in a cohort of 189 active-duty and retired U.S. military men living with HIV. Methods: Participants completed selected modules of the Composite International Diagnostic Interview (CIDI) to ascertain the presence of PTSD, major depressive disorder, and other mental health diagnoses. We also obtained demographic data, including history of head trauma, via personal interview. NCI was assessed with a comprehensive battery of standardized neuropsychological tests. Results: The median age of study subjects was 36 years (interquartile range [IQR] 28 to 43) and median total years of education was 14 (IQR 12 to 16). NCI was diagnosed in 19% of subjects. Individuals with and without a history of PTSD were similar with respect to most HIV-related characteristics; however, the former were significantly more likely to have a prior acquired immunodeficiency syndrome (AIDS) diagnosis. In multivariate analysis, lifetime history of PTSD was independently associated with NCI (odds ration [OR] = 6.12; 95% confidence interval [CI] = 1.85, 20.27), while a history of head of trauma was negatively associated (OR = 0.37 95% CI = 0.15,0.92). Conclusions: Our findings demonstrate that PTSD is an important predictor of NCI in this U.S. military cohort. HIV-infected individuals with cognitive difficulties should be screened for mental health disorders, including PTSD, and prospective studies of the longitudinal relationship between PTSD and NCI, as well as the impact of PTSD treatment on future NCI, are warranted.

Disclaimer

The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions, or policies of Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), the Departments of the Army, Navy, or Air Force, or the Henry M. Jackson Foundation for the Advancement of Military Medicine. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. government.

Disclosure Statement

The authors report no conflicts of interest associated with this research study.

Additional information

Funding

This study (IDCRP-016) was supported by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences (USUHS). This project has been funded in whole or in part with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter‐Agency Agreement (Y1-AI- 5072).

Notes on contributors

Robert Deiss

Robert Deiss, MD, Department of Preventive Medicine and Biostatistics Infectious Disease Clinical Research Program Uniformed Services University of the Health Sciences North Bethesda, MD.

Cdr. Justin Campbell

Cdr. Justin Campbell, PhD, Department of Pediatrics, East Carolina University, Greenville, NC.

Caitlin Wei-Ming Watson

Caitlin Wei-Ming Watson, PhD, San Diego State University/University of California San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA.

Raeanne C. Moore

Raeanne C. Moore, PhD, HIV Neurobehavioral Research Program, University of California, San Diego, Veterans Administration San Diego Health Care System San Diego, CA.

Nancy F. Crum-Cianflone

Nancy F. Crum-Cianflone, MD, Scripps Mercy Hospital, San Diego, CA.

Xun Wang

Xun Wang, MS, Uniformed Services University of the Health Sciences Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Henry M. Jackson Foundation, North Bethesda, MD.

Anuradha Ganesan

Anuradha Ganesan, MD, Uniformed Services University of the Health Sciences Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Henry M. Jackson Foundation, Division of Infectious Diseases, Walter Reed National Military Medical Center Bethesda, MD.

Lt. Col. Jason Okulicz

Lt. Col. Jason Okulicz, MD, MC, Infectious Disease Service, Brooke Army Medical Center San Antonio Military Medical Center, San Antonio, CA.

Scott Letendre

Scott Letendre, MD, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA.

Ryan C. Maves

Ryan C. Maves, MD, Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, CA.

David J. Moore

David J. Moore, MD, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA.