ABSTRACT

Objective:

Black Americans are at high risk for HIV disease and associated morbidity. The impact and clinical correlates of HIV-associated neurocognitive impairment among Black Americans is not fully understood. The current study uses a full factorial design to examine the independent and combined effects of race and HIV disease on neurocognitive functioning, including its associations with everyday functioning and clinical disease markers in Black and White persons with HIV (PWH).

Method:

Participants included 40 Black PWH, 83 White PWH, 28 Black HIV- and 64 White HIV- individuals. Neurocognition was measured by raw sample-based z-scores from a clinical battery. Everyday functioning was assessed using self- and clinician-rated measures of cognitive symptoms and activities of daily living. HIV-associated neurocognitive disorders were also classified using demographically adjusted normative standards and the Frascati criteria.

Results:

We observed a significant three-way interaction between HIV, race, and domain on raw neurocognitive z-scores. This omnibus effect was driven by medium and large effect size decrements in processing speed and semantic memory, respectively, in Black PWH compared to other study groups. Black PWH also demonstrated higher frequencies of HIV-associated neurocognitive disorders as compared to White PWH. Unexpectedly, global neurocognitive performance was negatively related to everyday functioning impairments for White PWH, but not for Black PWH.

Conclusions:

Systemic disadvantages for Black Americans may combine with HIV disease to compound some neurocognitive impairments in this under-served population. Prospective studies are needed to identify better ways to prevent, measure, diagnose, and manage HIV-associated neurocognitive disorders among Black Americans.

中文翻译：

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患有 HIV 疾病的美国黑人的神经心理健康差异的证据

摘要

客观的：

美国黑人患 HIV 疾病和相关疾病的风险很高。美国黑人中 HIV 相关的神经认知障碍的影响和临床相关性尚不完全清楚。目前的研究使用全因子设计来检查种族和 HIV 疾病对神经认知功能的独立和综合影响，包括其与感染 HIV 的黑人和白人 (PWH) 的日常功能和临床疾病标志物的关联。

方法：

参与者包括 40 名黑人 PWH、83 名白人 PWH、28 名黑人 HIV 感染者和 64 名白人 HIV 感染者。神经认知是通过来自临床电池的基于原始样本的 z 分数测量的。使用认知症状和日常生活活动的自我和临床医生评定的措施来评估日常功能。HIV 相关的神经认知障碍也使用人口统计学调整的规范标准和弗拉斯卡蒂标准进行分类。

结果：

我们在原始神经认知 z 分数上观察到 HIV、种族和域之间存在显着的三向相互作用。与其他研究组相比，Black PWH 中处理速度和语义记忆的中型和大型效应量分别降低了这种综合效应。与白色 PWH 相比，黑色 PWH 还表现出更高频率的 HIV 相关神经认知障碍。出乎意料的是，整体神经认知表现与白人 PWH 的日常功能障碍呈负相关，但与黑人 PWH 无关。

结论：

美国黑人的全身性劣势可能与艾滋病毒疾病相结合，在这个服务不足的人群中加剧了一些神经认知障碍。需要进行前瞻性研究，以确定更好的方法来预防、测量、诊断和管理美国黑人中与 HIV 相关的神经认知障碍。