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Published on: January 12, 2016
Perceived and post-traumatic stress are associated with decreased learning, memory, and fluency in HIV-infected women
Leah H Rubin1, Judith A Cook, Gayle Springer
1aDepartment of Psychiatry, University of Illinois at Chicago, Chicago, IL bDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD cDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD dCook County Health and Hospitals System/Hektoen Institute of Medicine, Chicago IL eDepartments of Medicine Stroger Hospital and Rush University, Chicago IL fDepartment of Psychiatry, Rush University Medical Center, Chicago, IL gMemory and Aging Center, Department of Neurology, University of California, San Francisco hInstitute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, CA iDepartments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY jDepartment of Medicine, Georgetown University, Washington, DC kDepartment of Neurology, SUNY-Downstate Medical Center, Brooklyn, NY lUniversity of California San Diego School of Medicine, La Jolla, CA mDepartment of Psychology, University of Illinois at Chicago, Chicago, IL.
Objective:
Psychological risk factors (PRFs) are associated with impaired learning and memory in HIV-infected (HIV+) women. We determined the dynamic nature of the effects of PRFs and HIV serostatus on learning and memory over time.
Design:
Multi-center, prospective cohort study METHODS:: Every two years between 2009 and 2013 (3 times), 646 HIV+ and 300 demographically-similar HIV-uninfected (HIV-) women from the Women's Interagency HIV Study completed neuropsychological (NP) testing and questionnaires measuring PRFs (perceived stress, post-traumatic stress disorder (PTSD) symptoms, depressive symptoms). Using mixed-effects regressions, we examined separate and interactive associations between HIV-serostatus and PRFs on performance over time.
Results:
HIV+ and HIV- women had similar rates of PRFs. Fluency was the only domain where performance over time depended on the combined influence of HIV-serostatus and stress or PTSD (p's < 0.05); not depression. In HIV, higher stress and PTSD were associated with a greater cognitive decline in performance (p's < 0.05) versus lower stress and PTSD. Irrespective of time, performance on learning and memory depended on the combined influence of HIV-serostatus and stress or PTSD (p's ≤ 0.05). In the context of HIV, stress and PTSD were negatively associated with performance. Effects were pronounced on learning among HIV+ women without effective treatment or viral suppression. Regardless of time or HIV-serostatus, all PRFs were associated with lower speed, global NP, and executive function.
Conclusions:
More than depression, perceived stress and PTSD symptoms are treatment targets to potentially improve fluency, learning, and memory in women living with HIV particularly when HIV treatment is not optimal.
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