Changes in cognitive function in women with HIV infection and early life stress

ABSTRACT

Introduction: HIV is frequently associated with deficits in brain function, including memory, psychomotor speed, executive function and attention. Early life stress (ELS) has also been shown to have a direct influence on neurocognitive performance. However, little is known about the combined impact of ELS and HIV on neurocognitive function over time. The aim of the present study was to follow a cohort of affected women, allowing us to assess the effects of HIV and childhood trauma on cognition and the change in cognition over time. Method: A battery of neurocognitive tests was administered to 117 women at baseline and then a year later. The sample included a total of 67 HIV⁺ and 50 HIV⁻ women, 71 with ELS and 46 without ELS. Controlling for age, education and antiretroviral therapy (ART) at baseline and 12-month follow-up, raw scores were compared across groups using a repeated-measures analysis of covariance. Results: More women were on ART at follow-up compared to baseline. Results revealed a significant combined HIV and childhood trauma effect over time on the Wisconsin Card Sorting Test (p = .003) and Category Fluency Test (p = .006). A significant individual HIV effect over time was evident on the WAIS-III Digit Symbol Test (p = .03) and the Controlled Oral Word Association Test (p = .003). Conclusion: Findings suggest better performance in abstract reasoning, speed of information processing and verbal fluency over time. While all groups showed improvements that may correspond to practice effects, effects of HIV and childhood trauma remained evident at 12-month follow-up despite greater ART uptake and improved HIV disease status. This is the first study to assess the combined impact of HIV and trauma on neurocognitive function over time in an all-female cohort with more advanced disease.

KEYWORDS:

• HIV/AIDS
• childhood trauma
• neurocognitive function
• neurocognitive change
• women

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work is supported by the South African Research Chair in PTSD awarded to S Seedat and hosted by Stellenbosch University, funded by the DST and administered by NRF and the Faculty of Medicine and Health Sciences, Stellenbosch University (Deputy Dean’s strategic fund for postdoctoral fellows and sub-committee C postdoctoral fellowship). Additional research support was provided by a CFAR grant awarded to S Seedat [P30-AI036214] and the HIV Neurobehavioral Research Center (HNRC; National Institutes of Health [grant number P30-MH62512]). Professor Martin Kidd from the department of Statistics and Actuarial Sciences of Stellenbosch University provided statistical assistance.