Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark.
J Neurovirol. 2022 Dec;28(4-6):537-551. doi: 10.1007/s13365-022-01093-0. Epub 2022 Sep 1.
Cognitive performance in people with HIV (PWH) may be affected by brain injury attributable to the infection itself, by other medical and psychiatric comorbidities (including major depressive disorder; MDD), and by psychosocial factors (e.g., education, food insecurity). We investigated effects of these variables on cognitive performance in a South African cohort of PWH with comorbid MDD and incomplete adherence to antiretroviral therapy (ART). We also examined (a) associations of depression severity with cognitive performance, and (b) whether improvement in depression led to improved cognitive performance. Participants (N = 105) completed baseline neuropsychological, psychiatric, and sociodemographic assessments. Subsequently, 33 were assigned to a cognitive-behavioural therapy for ART adherence and depression (CBT-AD) and 72 to standard-of-care treatment. Eight months post-baseline, 81 (n = 29) repeated the assessments. We investigated (a) baseline associations between sociodemographic, medical, and psychiatric variables and cognitive performance, (b) whether, from baseline to follow-up, depression and cognitive performance improved significantly more in CBT-AD participants, and (c) associations between post-intervention improvements in depression and cognitive performance. At baseline, less education (β = 0.62) and greater food insecurity (β = -0.20) predicted poorer overall cognitive performance; more severe depression predicted impairment in the attention/working memory domain only (β = -0.25). From baseline to follow-up, depression decreased significantly more in CBT-AD participants (p = .017). Improvement over time in depression and cognitive performance was not significantly associated except in the attention/working memory domain (p = .026). Overall, factors associated with cognitive performance were unrelated to brain injury. We conclude that clinicians examining PWH presenting with cognitive difficulties must assess depression, and that researchers investigating cognitive impairment in PWH must collect information on psychosocial factors.
艾滋病毒感染者（PWH）的认知表现可能受到以下因素的影响：感染本身导致的脑损伤、其他医学和精神共病（包括重度抑郁症；MDD）以及心理社会因素（例如，教育、食物不安全）。我们在一个南非 PWH 合并 MDD 和抗逆转录病毒治疗（ART）不依从的队列中研究了这些变量对认知表现的影响。我们还检查了：（a）抑郁严重程度与认知表现的关联，以及（b）抑郁改善是否导致认知表现改善。参与者（N=105）完成了基线神经心理学、精神病学和社会人口统计学评估。随后，33 名参与者被分配到认知行为疗法治疗 ART 依从性和抑郁（CBT-AD），72 名参与者被分配到标准护理治疗。基线 8 个月后，81 名参与者（n=29）重复了评估。我们调查了：（a）基线时社会人口学、医学和精神病学变量与认知表现之间的关联，（b）从基线到随访，CBT-AD 参与者的抑郁和认知表现是否显著改善，以及（c）干预后抑郁和认知表现改善之间的关联。基线时，受教育程度较低（β=0.62）和食物不安全程度较高（β=-0.20）预测整体认知表现较差；更严重的抑郁仅预测注意力/工作记忆域的损害（β=-0.25）。从基线到随访，CBT-AD 参与者的抑郁显著下降（p=0.017）。抑郁和认知表现随时间的改善没有显著关联，除了在注意力/工作记忆域（p=0.026）。总体而言，与认知表现相关的因素与脑损伤无关。我们得出结论，检查出现认知困难的 PWH 的临床医生必须评估抑郁，研究 PWH 认知障碍的研究人员必须收集心理社会因素的信息。
