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HIV-associated neurocognitive disorder in Australia: a case of a high-functioning and optimally treated cohort and implications for international neuroHIV research

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Abstract

The Australian HIV-infected (HIV+) population is largely comprised of high-functioning men who have sex with men (MSM). Like other English-speaking countries, Australia mostly relies on US neuropsychological normative standards to detect and determine the prevalence of neurological disorders. Whether the US neuropsychological (NP) normative standards are appropriate in Australian HIV+ MSM has not been established. Ninety virally suppressed HIV+ and 49 HIV-uninfected (HIV−) men (respectively 86 and 85 % self-reported MSM; mean age 54 and 56 years, mean premorbid verbal IQ estimate 110 and 111) undertook standard NP testing. The raw neuropsychological data were transformed using the following: (1) US standards as uncorrected scaled scores and demographically corrected T scores (US norms); and (2) z scores (without demographic corrections) derived from Australian comparison group scaled scores (local norms). To determine HIV-associated neurocognitive disorder prevalence, we used a standard definition of impairment based upon a battery-wide summary score: the global deficit score (GDS). Impairment classification (GDS ≥ 0.5) based on the local norms was best at discriminating between the two groups (HIV− = 14.3 % vs. HIV+ = 53.3 %; p < 0.0001). This definition was significantly associated with age. Impairment classification based on the US norms yielded much lower impairment rate regardless of the HIV status (HIV− = 4.1 % vs. HIV+ = 14.7 %; p = 0.05), but was associated with historical AIDS, and not age. Both types of summary scores were associated with reduced independence in activities of daily living (p ≤ 0.03). Accurate neuropsychological classifications of high (or low) functioning individuals may need country-specific norms that correct for performance-based (e.g., reading) estimates of premorbid cognition in addition to the traditional demographic factors.

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Acknowledgments

We would like to thank Dr. Mark Bloch, director of the Holdsworth House General Practice for facilitating the co-enrolment of his HIV− cohort into the HIV and aging cohort. We would also like to thank the HIV physicians and the nursing staff at the Immunology and Infectious Diseases Department of St. Vincent’s Hospital for their support and investment in the study. Last but not least, we would like to give a special thanks to all our participants for their time and involvement in the project.

Conflict of interest

Lucette A. Cysique: This study was supported by the National Health and Medical Research Council of Australia project grant ID568746 (Cysique CIA/PI), the 2009–2012 postdoctoral Brain Science UNSW fellowship (Cysique), 2012 Mercks Sharp Dome (MSD) partial salary support for 2012, the National Health and Medical Research Council of Australia Career Development Fellowship APP1045400 (Cysique CIA/PI), and the Peter Duncan Neurosciences Unit (Head Prof. Bruce Brew). MSD had no direct participation in the current study design, data analyses, and interpretation. Dr. Cysique has otherwise no conflict of interest with the organizations that funded this research. Robert K. Heaton, Jody Kamminga, Tammy Lane, Thomas M. Gates, Danielle M. Moore, and Emma Hubner have no conflict of interest with the organizations that funded this research. Andrew Carr has received grants from the National Health and Medical Research Council of Australia, has received research funding, consultancy fees, lecture and travel sponsorships from MSD, and has served on advisory boards for MSD. Bruce J. Brew has received grants from the National Health and Medical Research Council of Australia, had received payment as board member for MSD, and received travel/accommodation expenses covered or reimbursed by MSD.

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Authors and Affiliations

  1. St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia

    Lucette A. Cysique, Thomas M. Gates, Andrew Carr & Bruce J. Brew

  2. Neuroscience Research Australia, Sydney, Australia

    Lucette A. Cysique & Jody Kamminga

  3. Neurology and Imaging and HIV Departments, St. Vincent’s Hospital, Sydney, Australia

    Lucette A. Cysique, Tammy Lane & Bruce J. Brew

  4. St. Vincent’s Hospital Centre for Applied Medical Research, Sydney, Australia

    Lucette A. Cysique, Jody Kamminga, Thomas M. Gates, Danielle M. Moore, Emma Hubner, Andrew Carr & Bruce J. Brew

  5. HIV Neurobehavioral Research Center (HNRC), Department of Psychiatry, University of California at San Diego, San Diego, CA, USA

    Robert K. Heaton

  6. HIV, Immunology and Infectious Diseases Unit, St. Vincent’s Hospital, Sydney, Australia

    Andrew Carr

  7. Neuroscience Research Australia, PO Box 1165, Randwick NSW, Australia

    Lucette A. Cysique

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  1. Lucette A. Cysique
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Correspondence to Lucette A. Cysique.

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Cysique, L.A., Heaton, R.K., Kamminga, J. et al. HIV-associated neurocognitive disorder in Australia: a case of a high-functioning and optimally treated cohort and implications for international neuroHIV research. J. Neurovirol. 20, 258–268 (2014). https://doi.org/10.1007/s13365-014-0242-x

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