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J Int Neuropsychol Soc. 2018 Feb;24(2):163-175. doi: 10.1017/S1355617717000832. Epub 2017 Sep 6.

Differences in Neurocognitive Impairment Among HIV-Infected Latinos in the United States.

Author information

1
1Department of Psychiatry,University of California,San Diego,California.
2
2Advancing Diversity through Aging Research (ADAR) Program,San Diego State University,San Diego,California.
3
3Department of Psychology,Fordham University,Bronx,New York.
4
4Department of Medicine,Vanderbilt University,Nashville,Tennessee.
5
5Department of Psychology,University of Alabama Birmingham,Birmingham,Alabama.
6
6Department of Neurology,Mount Sinai Medical Center,Miami,Florida.
7
7Department of Medicine,University of California,San Diego,California.
8
8Department of Neurosciences,University of California,San Diego,California.
9
9Department of Neurology,University of Washington,Seattle,Washington.
10
11Department of Pathology,University of Texas Medical Branch,Galveston,Texas.
11
12Department of Neurology,Johns Hopkins University,Baltimore,Maryland.

Abstract

OBJECTIVES:

Human immunodeficiency virus (HIV) disproportionately affects Hispanics/Latinos in the United States, yet little is known about neurocognitive impairment (NCI) in this group. We compared the rates of NCI in large well-characterized samples of HIV-infected (HIV+) Latinos and (non-Latino) Whites, and examined HIV-associated NCI among subgroups of Latinos.

METHODS:

Participants included English-speaking HIV+ adults assessed at six U.S. medical centers (194 Latinos, 600 Whites). For overall group, age: M=42.65 years, SD=8.93; 86% male; education: M=13.17, SD=2.73; 54% had acquired immunodeficiency syndrome. NCI was assessed with a comprehensive test battery with normative corrections for age, education and gender. Covariates examined included HIV-disease characteristics, comorbidities, and genetic ancestry.

RESULTS:

Compared with Whites, Latinos had higher rates of global NCI (42% vs. 54%), and domain NCI in executive function, learning, recall, working memory, and processing speed. Latinos also fared worse than Whites on current and historical HIV-disease characteristics, and nadir CD4 partially mediated ethnic differences in NCI. Yet, Latinos continued to have more global NCI [odds ratio (OR)=1.59; 95% confidence interval (CI)=1.13-2.23; p<.01] after adjusting for significant covariates. Higher rates of global NCI were observed with Puerto Rican (n=60; 71%) versus Mexican (n=79, 44%) origin/descent; this disparity persisted in models adjusting for significant covariates (OR=2.40; CI=1.11-5.29; p=.03).

CONCLUSIONS:

HIV+ Latinos, especially of Puerto Rican (vs. Mexican) origin/descent had increased rates of NCI compared with Whites. Differences in rates of NCI were not completely explained by worse HIV-disease characteristics, neurocognitive comorbidities, or genetic ancestry. Future studies should explore culturally relevant psychosocial, biomedical, and genetic factors that might explain these disparities and inform the development of targeted interventions. (JINS, 2018, 24, 163-175).

KEYWORDS:

Cognitive function; Culture; Health status disparities; Hispanics; Human immunodeficiency virus; Minority health

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