The Association of Memory Disorders and Chronic HIV Disease in the Antiretroviral Therapy Era

A Systematic Literature Review

E Ripamonti; M Clerici

Disclosures

HIV Medicine. 2020;21(1):9-20. 

In This Article

Abstract and Introduction

Abstract

Objectives: Despite recent pharmacological progress, memory impairment is still frequently reported in people living with HIV. We aimed to conduct a systematic literature review investigating the presence of impairment of (sub)components of memory function in patients prescribed highly active antiretroviral therapy (ART).

Methods: We adopted a cognitive neuropsychological model of memory function as the theoretical framework, distinguishing between a short-term working memory component and a long-term component of memory, along with their specific (sub)components. We systematically searched for the presence of impairment of each (sub)component in the selected papers. Careful consideration was given to study design and methods and control of covariates.

Results: Only the central executive component of working memory has been consistently reported to be impaired in HIV infection. The other two (sub)components, namely the phonological loop and the visuospatial sketchpad, were unimpaired. Discordant results have been obtained as to verbal and visual episodic memory, as some authors reported an association with HIV infection, whereas others did not. There is little evidence for semantic memory deficit in HIV infection, while there are suggestions that the neural substrate of implicit memory may be damaged by the effects of HIV infection and inflammation. Most studies in this area have been conducted in small samples and with poor control for covariates. Thus, conclusions regarding the association of memory dysfunction with HIV infection are hampered by methodological issues such as selection bias and unmeasured confounding.

Conclusions: The task remains for future research to ascertain the impact of HIV infection on memory function.

Introduction

Memory is a multicomponent function that is essential to accomplish most of the activities of everyday life.[1] In the 1980s, it first became evident that HIV infection can have neurological effects that may lead to cognitive impairment.[2] To describe the most advanced stage of HIV-related cognitive impairment, researchers originally coined the term 'AIDS dementia complex'.[3,4] Today, thanks to the progress made in treating HIV infection using antiretroviral therapy (ART), the prevalence of this impairment has decreased considerably, at least in developed countries.[5] Nevertheless, mild but occasionally insidious memory disorders are still reported in a fraction of patients with HIV-1 infection (see Data S1), at relatively unpredictable stages of the disease.[5,6] Memory impairment can be one of the deficits defining so-called HIV-associated neurocognitive disorder (HAND)[6] and is one of the serious non-AIDS-related complications and comorbidities of chronic HIV infection that can only partially be controlled by ART.[7]

The objective of this paper is to review evidence regarding the association of memory dysfunction with HIV infection. We considered descriptive and observational studies including patients treated with ART, and we adopted a cognitive neuropsychological model of memory functions as the theoretical framework (see Data S1). We also studied the role of covariates that may be associated with memory and cognitive impairment, such as ageing, time from seroconversion, adherence to pharmacotherapy, nadir and current CD4 cell counts, HIV RNA plasma levels, and the presence of comorbidities such as diabetes or cardiovascular disease.

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