Despite typically being mild and fluctuating in nature, HIV-associated complications can affect multiple aspects of life. For example, Heaton and colleagues demonstrated that those with impairment were twice as likely to be unemployed as persons without impairment. Also, even among the employed, those with mild impairment were performing at a level less
Figure 7 One-year progression of neurocognitive complications. HAD, HIV-1-associated dementia; NP, neuropschological; MCMD, minor cognitive motor disorder; WNL, within normal limits.
than expected based on uninfected comparison groups and also on infected but not impaired controls. Neuropsychological impairment associated with HIV may also affect important life activities, such as driving and medication management. For example, Marcotte and colleagues, utilizing the driving simulator, noted that those with impairment had more simulated accidents than the unimpaired. Recent data suggest that such individuals also had more actual on-road accidents and incidents. Recent observation at the HNRC also indicates that those with neuropsychological impairment may have more difficulties with managing their antiretroviral medication regimens. For example, Fig. 9 shows that more of the mildly impaired patients fail to take their medications as scheduled or as directed.
The presence of neurocognitive complications also predicts earlier death. For example, Ellis and colleagues noted that patients with MCMD had a median survival of 2.2 years, and those with asymptomatic neuropsychological impairment 3.8 years, versus 5.1 years for those who were neurocognitively normal. Adjustment of the survival analysis for CD4 count and other disease indicators revealed an independent effect for neurocognitive impairment. The mechanism for this remains unclear, but similar data were also reported from the Columbia University cohort.
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