1 / 55

Neurobehavioral and Neuropsychiatric Aspects of HIV/AIDS: An Update

Neurobehavioral and Neuropsychiatric Aspects of HIV/AIDS: An Update. Eileen Martin, PhD Departments of Psychiatry and Neurology University of Illinois at Chicago Supported by HHS DA R01 12828 and DA R01 13800. Objectives.

sawyer
Télécharger la présentation

Neurobehavioral and Neuropsychiatric Aspects of HIV/AIDS: An Update

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Neurobehavioral and Neuropsychiatric Aspects of HIV/AIDS:An Update Eileen Martin, PhD Departments of Psychiatry and Neurology University of Illinois at Chicago Supported by HHS DA R01 12828 and DA R01 13800

  2. Objectives • Review recent findings in psychiatric and neurocognitive aspects of HIV/AIDS • Impact of introduction of HAART on research and clinical questions • Changes in the face of the epidemic

  3. Cumulative US Reported AIDS Cases1997 9% 32% 49%

  4. 2005 US AIDS SurveillanceMales 8% 11% 59% 20%

  5. US AIDS Surveillance 2005Women 33% 65%

  6. Previous Questions • Dementia • Diagnosis • Prognostic indicators • Time to death

  7. New Questions • Vulnerability and Risk Factors • Critical outcomes • Aging • Multidisciplinary Perspective

  8. NeuroAIDS: Overview

  9. NeuroAIDS – General Comments • HIV has an affinity for the CNS • Neuropathology Highlights • Basal Ganglia – highest viral load • Cerebral White Matter • Prefrontal cortical neuron loss • Hippocampus

  10. Continuing problem in the era of HAART • No effective treatment for neuroAIDS • Interaction with age and other risks • Outcome variables have changed

  11. Caudate Amygdala * * * Hippocampus

  12. State of the Art 1988

  13. Abnormal Brain Activity Precedes Cognitive Problems

  14. Neurocognitive Effects of HIV

  15. Grant, 2005 HIV-associated cognitive impairment

  16. Criteria for HIV-related dementia • Marked acquired impairment in at least 2 ability domains (attention, memory, mental or motor speed) • Marked interference with daily functioning • Present for at least one month • Does not meet criteria for delirium • No evidence of a preexisting condition that could cause the cognitive deficits Grant & Atkinson, 1995

  17. McArthur et al., 1997

  18. Model Patient’s Copy Time: 14 minutes

  19. NeuroAIDS and Cognition • Mental/Motor Slowing • Impaired Attention • Episodic Memory • Executive Deficits

  20. Functional Consequences of NeuroAIDS

  21. Driving

  22. Standardized Work Samples Heaton et al, 1994

  23. Activities of Daily Living Heaton et al., 1994

  24. Employment * HIV+ NP normal HIV- HIV+ NP abnormal Women’s Interagency HIV Study – Chicago Consortium

  25. Medication Management Albert et al, 1999

  26. Comorbid Conditions

  27. Direct and Indirect Effects on Brain IDU IFN/RBV Depression

  28. Rates of NP Abnormality - HIV and HCVWomen’s Interagency HIV Study * * Richardson et al., AIDS, 2006

  29. Mental Processing is Slowerwith Coinfection * p < .05

  30. What are the Risk Factors for Cognitive Impairment Among HIV+ Persons? • Age • Education – “Cognitive Reserve” • Head Trauma • Antiretroviral Status

  31. Aging and HIV • Greater non-HIV dementia risk • Diabetes, Hypertension, etc • Menopause • Increased prevalence of depression • Vulnerable executive functions Increase from 1000 to 10000 in past decade Estimated 50% of all cases by 2015

  32. Youth and NP Issues • Brain development is incomplete • Increasing rates among minority youth • Higher propensity for risk taking • 45% are MSM • View AIDS as chronic but not deadly

  33. NP Performance of HIV+ Women and HIV-Controls - Women’s Interagency Study p < .01 HIV+ ARV HIV+ No ARV HIV- Richardson et al., JINS 2002

  34. And then there’s substance dependence

  35. Substance Dependence and HIVGeneral Points • Not All IDU, not all Illegal • Alcohol, Prescription Meds • Does Not Explain All HIV NP deficits • Does SD add to or interact with neuroAIDS?

  36. Perceived poor adherence risk by providers • Active alcohol abuse or IDU • Homelessness • Depression > 50% • History of IDU • History of alcohol abuse 21-49% • Mother of small children • Low education • Ethnic minority or low income 10-20%

  37. Methamphetamine • Synthetic CNS stimulant drug • 12.3 million (5.2%) Americans > 12 years old have tried it NSDUH, 2003 • Relatively easy to make

  38. Club Drugs • Controversy over MDMA neurotoxicity • Superseded by CM • Difficult to study - Polydrug use

  39. Working Memory Performance

  40. New Cognitive Topics:Decision-Making • Ability to Make Choices in the Present Leading to the Best Outcome in the Future • Orbitofrontal, ventromedial prefrontal cortex

  41. Decision-Making for Medical Students • Current Choices • Partying • Sleeping • Sex • Studying • Best Outcome in Future • GRADUATING

  42. The Iowa Gambling Task Bechara et al., 1997

  43. HIV+ Drug Users Make More Risky Decisions * p < .05 Martin et al., JINS, 2004

  44. Prospective Memory • “Remembering to remember” • Memory for a Future Action • Implications for Adherence

More Related