Cognitive Trajectory Phenotypes in Human Immunodeficiency Virus-Infected Patients

Area of Science:

• Neuroscience
• Infectious Diseases
• Psychology

Background:

• Antiretroviral therapies have altered the presentation of cognitive impairments in HIV-infected individuals.
• While frank dementia is now rare, milder cognitive impairments persist and are the predominant form.
• The heterogeneous causes of residual cognitive dysfunction in this population have made mechanistic insights elusive.

Purpose of the Study:

• To categorize longitudinal changes in cognitive domains among HIV-infected patients.
• To identify distinct patterns of cognitive change in individuals with HIV.
• To understand the underlying neural network perturbations associated with cognitive decline.

Main Methods:

• Utilized data from 193 participants in the CHARTER cohort with two study visits approximately 6 months apart.
• Conducted comprehensive neuropsychological testing across multiple cognitive domains, including executive function, learning, memory, fluency, processing speed, and motor skills.
• Applied principal component analysis and k-means clustering to identify patterns of cognitive change.

Main Results:

• Identified four distinct cognitive change phenotypes in HIV-infected individuals.
• These phenotypes represented declines in: (1) verbal fluency, (2) executive function, (3) learning and delayed recall, and (4) motor function.
• Approximately equal numbers of participants were observed in each of the four identified phenotypes.

Conclusions:

• The four identified cognitive change phenotypes suggest perturbations in specific neural networks.
• These findings provide a framework for understanding residual cognitive impairments in HIV.
• Future research should validate the association between these cognitive phenotypes and specific neural pathway alterations.