Neurocognitive impairment in Spanish-speaking Latinos living with HIV in the US: Application of the neuropsychological norms for the US–Mexico border region in Spanish (NP-NUMBRS)

Abstract

Objective

Latinos in the US are at increased risk for HIV-associated neurocognitive impairment (NCI). Most studies of US Latinos living with HIV have included primarily English-speakers only. We investigated the rate, pattern, and correlates of HIV-associated NCI in native Spanish-speaking Latinos living in the US near the Mexican border.

Methods

Participants included 407 native Spanish-speaking Latinos (Age: M = 37.65, SD = 10.0; Education: M = 10.75, SD = 4.1; 53% male): 153 persons living with HIV (PLWH; 56% AIDS) and 254 healthy controls. All participants completed comprehensive neuropsychological assessments in Spanish. Raw neuropsychological test scores from seven domains were converted to demographically-adjusted T-scores using norms developed with healthy controls. Global and domain NCI were defined per established criteria. Among PLWH we applied norms developed for non-Hispanic (NH) Whites and Blacks, and investigated correlates of global NCI, including HIV disease characteristics and psychiatric comorbidities.

Results

Utilizing population specific norms, rates of global NCI were significantly higher among PLWH (39%) than healthy controls (17%), comparable to previously published rates. In contrast, rates of global NCI in the same group of PLWH were significantly different when NH White norms (63%, p < 0.0001) and NH Black norms were used (18%, p < 0.0001). Among PLWH without a history of lifetime substance use disorder, more years of antiretroviral exposure were significantly associated with decreased rates of global NCI.

Conclusions

Present findings lend support to the validity of newly developed norms for native Spanish-speakers living near the US-Mexico border, and underscore the importance of utilizing appropriate norms to accurately identify HIV-associated NCI.

KEYWORDS:

• Hispanic/Latino
• neuropsychological assessment
• norms
• HIV
• cognition

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by grants from the National Institutes of Health (The HIV Neurobehavioral Research Center (HNRC): P30MH62512, R01MH57266, K23MH105297, P30AG059299, T32MH019934, P01DA012065) and the UCSD Hispanic Center of Excellence. The HIV Neurobehavioral Research Center (HNRC) is supported by Center award P30MH062512 from NIMH. The San Diego HIV Neurobehavioral Research Center [HNRC] group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the Veterans Affairs San Diego Healthcare System, and includes: Director: Robert K. Heaton, Ph.D., Co-Director: Igor Grant, M.D.; Associate Directors: J. Hampton Atkinson, M.D., Ronald J. Ellis, M.D., Ph.D., and Scott Letendre, M.D.; Center Manager: Jennifer Iudicello, Ph.D.; Donald Franklin, Jr.; Melanie Sherman; NeuroAssessment Core: Ronald J. Ellis, M.D., Ph.D. (P.I.), Scott Letendre, M.D., Thomas D. Marcotte, Ph.D, Christine Fennema-Notestine, Ph.D., Debra Rosario, M.P.H., Matthew Dawson; NeuroBiology Core: Cristian Achim, M.D., Ph.D. (P.I.), Ana Sanchez, Ph.D., Adam Fields, Ph.D.; NeuroGerm Core: Sara Gianella Weibel, M.D. (P.I.), David M. Smith, M.D., Rob Knight, Ph.D., Scott Peterson, Ph.D.; Developmental Core: Scott Letendre, M.D. (P.I.), J. Allen McCutchan; Participant Accrual and Retention Unit: J. Hampton Atkinson, M.D. (P.I.) Susan Little, M.D., Jennifer Marquie-Beck, M.P.H.; Data Management and Information Systems Unit: Lucila Ohno-Machado, Ph.D. (P.I.), Clint Cushman; Statistics Unit: Ian Abramson, Ph.D. (P.I.), Florin Vaida, Ph.D. (Co-PI),, Anya Umlauf, M.S., Bin Tang, M.S. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government.