Factors Predicting Detrimental Change in Declarative Memory Among Women With HIV: A Study of Heterogeneity in Cognition

• Type of Material: Article
• Authors: Kathryn C. Fitzgerald, Johns Hopkins University; Pauline M. Maki, University of Illinois; Yanxun Xu, Johns Hopkins University; Wei Jin, Johns Hopkins University; Raha Dastgheyb, Johns Hopkins University; Dionna W. Williams, Johns Hopkins University; Gayle Springer, Johns Hopkins University; Kahtryn Anastos, Albert Einstein College of Medicine; Deborah Gustafson, SUNY Downstate Medical Center; Amanda B. Spence, Georgetown University; Adaora A. Adimora, University of North Carolina; Drenna Waldrop, Emory University; David E. Vance, University of Alabama Birmingham; Hector Bolivar, University of Miami; Victor G. Valcour, University of California San Francisco; Leah H. Rubin, Johns Hopkins University
• Language: English
• Date: 2020-10-15
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Fitzgerald, Maki, Xu, Jin, Dastgheyb, Williams, Springer, Anastos, Gustafson, Spence, Adimora, Waldrop, Vance, Bolivar, Valcour and Rubin
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fpsyg.2020.548521
• Title of Journal or Parent Work: FRONTIERS IN PSYCHOLOGY
• Volume: 11
• Start Page: 548521
• End Page: 548521
• Grant/Funding Information: KF was supported by 1K01MH121582-01 from NIH/NIMH and TA-1805-31136 from the National MS Society. This work was supported by the Johns Hopkins University NIMH Center for novel therapeutics for HIV-associated cognitive disorders (P30MH075773) 2018 pilot award to LR. DWW effort was supported by K99DA044838. The data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). WIHS (Principal Investigators): UAB-MS WIHS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos and Anjali Sharma), U01-AI-035004; Brooklyn WIHS (Deborah Gustafson and Tracey Wilson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye and Daniel Merenstein), U01-AI-034994; Miami WIHS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Bradley Aouizerat and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam), U01-HD-032632 (WIHS I – WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR000454 (Atlanta CTSA), P30-AI-050410 (UNC CFAR), and P30-AI-027767 (UAB CFAR).
• Keywords: STRESS; phenotyping; PROFILE; longitudinal; INTERAGENCY HIV; declarative memory; Psychology; LITERACY; Social Sciences; VERBAL MEMORY; women; DRUG-USE; PERFORMANCE; NEUROPSYCHOLOGICAL IMPAIRMENT; HIV; Psychology, Multidisciplinary
• Research Categories: Psychology, Behavioral; Biology, Virology; Psychology, Cognitive

Abstract

Objective: Statistical techniques used to study cognitive function in HIV typically yield normative estimates and can mask the heterogeneity in cognitive trajectories over time. We applied a novel statistical approach to identify clusters of individuals with distinct patterns of change in declarative memory in HIV-seropositive (HIV+) and HIV-seronegative (HIV−) women. Methods: 1731 women from the Women’s Interagency HIV Study, a multi-center, prospective cohort study, completed the Hopkins Verbal Learning Test-Revised (HLVT-R) at >2 visits. To derive subgroups with similar patterns of decline by HIV-serostatus, we used a mixed-effects framework that modeled the trajectory of multiple declarative memory outcomes over time, while simultaneously clustering individuals. Results: Of the 1731 participants, 1149 were HIV+ (70% Black/African American [AA]; 30% White/Other [W/O]) and 582 were HIV− (68% AA; 32% W/O). Race stratification was necessary to optimize clustering. Among HIV+AA’s, four subgroups emerged: a subgroup with minimal decline, two with accelerated decline, and one with stable but low performance. In HIV− AA, three subgroups emerged: one with minimal decline and two with accelerated decline. In multivariable-adjusted models among HIV+, individuals with accelerated decline were less educated (P < 0.001) and more likely to have a history of depression (P < 0.001) versus those with minimal decline. Similar subgroups were identified in W/O HIV+ and W/O HIV− participants. Conclusion: We identified clinically meaningful subgroups of women with distinct phenotypes of declarative memory decline, which depend on race and HIV-serostatus using a data driven approach. Identification of underlying mechanisms and risk factors contributing to the observed differences are warranted. More broadly our modeling approach could be other populations to identify risk factors for accelerated cognitive decline and to personalize interventions.