For Concepts Writer Only

NEUROCOGNITIVE PROBLEMS IN ANTI-RETROVIRAL THERAPY. 1

Grant Proposal: Neurocognitive Problems Caused by Anti-Retroviral Therapy

La’Shawn Tubman

PSY: 625

Teresa Barttrum

October 8, 2018

Specific Aims.

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1. Barttrum

Barttrum, Psy. D. - please use

my credentials on the title

page [Teresa Barttrum]

NEUROCOGNITIVE PROBLEMS IN ANTI-RETROVIRAL THERAPY. 2

As noted by Bhatti, Usman & Kandi, (2016), HIV/AIDS has grown to become a disease

burden of great public health concern among all populations since its discovery that dates back to

the year 1968. Approximately 38.6 million individuals live with HIV/AIDS globally and more

than 25 million have died so far. In the year 2014, new HIV infections were 4.2 million and

AIDS-related deaths were 3.0 million (Watkins & Treisman, 2015). With regards to these

estimates, the dynamic nature of HIV/AIDS as a rapidly evolving epidemic with regards to its

epidemiology and transmission are concealed. To date, every region across the globe is touched

by the HIV/AIDS pandemic.

Over the years, extensive research in treatment and management modalities for

HIV/AIDS patients has yielded different results. Currently, available HAART treatment regimens

yield good results which contribute positively to the quality of life and improved health

outcomes by increasing the number of CD4 cell count and decreasing the viral load to prevent

high chances of transmission (Mwesigire et al., 2015). However, the medications that are

currently in use have a wide range of neurocognitive effects that contribute to several cognitive

behavioral problems among patients with HIV/AIDS who are under ARV treatment. For

healthcare providers, cognitive impairment is a huge barrier to managing risky behaviors which

increases the mortalities and morbidity rates (Kenedi & Goforth, 2011). Therefore, this paper

seeks to extensively analyze the neurocognitive problems which are caused by ARV therapy

among patients diagnosed with HIV/AIDS.

Annotated Bibliography

Anand, P., Springer, S. A., Copenhaver, M. M., & Altice, F. L. (2010). Neurocognitive

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1. Therefore, this paper

seeks to extensively

analyze the neurocognitive

problems which are caused

by ARV therapy among

patients diagnosed with

HIV/AIDS.

You have a great introduction,

but this sentence is the only

line that address the

guidelines for this section.

You were to include: [Teresa

Barttrum]

2. Annotated Bibliography

this should begin on a new

page; see formatting [Teresa

Barttrum]

NEUROCOGNITIVE PROBLEMS IN ANTI-RETROVIRAL THERAPY. 3

Impairment and HIV Risk Factors: A Reciprocal Relationship. AIDS and Behavior, 14(6),

1213–1226.

Pria Anand, Sandra Springer, Michael Copenhaven, and Frederick Altice draw their

extensively-researched findings from their backgrounds in infectious diseases, AIDS, and

psychology programs. The researchers determine the relationship between cognitive impairment

and HIV among patients. They find an association between HIV risk-behaviors, adherence to

medication among other cofactors and cognitive function. More importantly, this research draws

from multiple literature sources to determine the reciprocal relationship between the two

variables under study. Pria and her team of researchers acknowledge the role that arises in risk

behaviors play in the development of neurocognitive impairment, particularly among optimized

medication. These findings are useful for guiding the scope of research for this paper.

Ances, B. M., & Clifford, D. B. (2008). HIV-Associated Neurocognitive Disorders and the

Impact of Combination Antiretroviral Therapies. Current Neurology and Neuroscience

Reports, 8(6), 455–461.

Bau Ances and David Clifford have established researchers at the Department of

Neurology at the University of Washington. This background provides them with a guided

academic and expert understanding of the functioning of the human neurological system. In this

study, the duo recognizes the role of HIV-associated neurocognitive disorder as a precursor to

dementia. According to the researchers, dementia is the most severe form of HIV-associated

neurocognitive disorder and is further induced with antiretroviral therapy. However, they note

that less severe cases of neurocognitive disorders are more prevalent with antiretroviral therapy.

This observation is key to the study as it explains the different results resulting from the study of

the correlations between the studied variables.

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NEUROCOGNITIVE PROBLEMS IN ANTI-RETROVIRAL THERAPY. 4

Awori, V., Mativo, P., Yonga, G., & Shah, R. (2018). The association between asymptomatic

and mild neurocognitive impairment and adherence to antiretroviral therapy among

people living with human immunodeficiency virus. Southern African Journal of HIV

Medicine, 19(1), 674.

Violet Awori, Peter Mativo, Gerald Yonga, and Reena Shah’s research are based on a

sample of patients visiting a hospital in Sub-Saharan Africa, one of the most affected areas by the

disease. The setting, therefore, provides an optimal environment to find a more informed

correlation between the variables. The researchers’ aim to determine the degree of the association

between adherence to antiretroviral therapy and neurocognitive impairment. At 128, the sample

size is also large enough to provide sufficient data. In their study, the researchers determined a

correlation between mild neurocognitive impairment and antiretroviral therapy among 69 percent

of the sample.

Bhatti, A. B., Usman, M., & Kandi, V. (2016). Current Scenario of HIV/AIDS, Treatment

Options, and Major Challenges with Compliance to Antiretroviral Therapy. Cureus, 8(3),

515.

Adnan Bashir, Muhammad Usman, and Venkataramana Kandi all have academic and practitioner

awareness of the effects of HIV from their application of academic knowledge to medical

therapy. In this study, they seek to determine current HIV scenario, the available options for

treatment of the disease, and the challenges that patients have with antiretroviral therapy. This

approach provides a holistic understanding of the disease and the available treatment options as

well as the outcome of such treatment. The development of the study is progressive, with a

review of the attempts at containing the disease and why medical options fail to achieve their

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NEUROCOGNITIVE PROBLEMS IN ANTI-RETROVIRAL THERAPY. 5

objective. This study is relevant as it gives a complete understanding of the variables. Borjabad,

A., Morgello, S., Chao, W., Kim, S.-Y., Brooks, A. I., Murray, J., Volsky, D. J.

(2011). Significant Effects of Antiretroviral Therapy on Global Gene Expression in Brain

Tissues of Patients with HIV-1-Associated Neurocognitive Disorders. PLoS Pathogens, 7(9),

e1002213.

This study is the product of a team of eight researchers who are experienced in the fields

of molecular virology, pathology and neuroscience, human genomics, genetics and occupational

health, and pathology. These backgrounds provide a spectrum of knowledge into the

understanding of the relationship among disease, treatment schedules, and the patient. The study

follows a unique path in its attempt to explain the rise of neurocognitive impairments in the wake

of antiretroviral therapy breakthroughs. The use of genomic analysis to compare the gene

expression profiles among both treated and untreated samples is a unique undertaking, but that

which provides insight that is needed to understand the scope of the study.

Cysique, L. A., Vaida, F., Letendre, S., Gibson, S., Cherner, M., Woods, S. P., llis, R. J.

(2009). Dynamics of cognitive change in impaired HIV-positive patients initiating

antiretroviral therapy. Neurology, 73(5), 342–348.

Cysique, Vaida, Letendre, Gibson, Cherner, Woods, McCutchan, Heaton, and Ellis have

all contributed immensely to the study of HID and its treatment. This background provides them

with the understanding of the response of patients to rugs. However, their focus on the less

understood psychological and neurological aspects of HIV patients under antiretroviral therapy

provides insight that is relevant to the study. The study aims to evaluate the cognitive change in

HIV patients over a period of time. To understand the correlation between antiretroviral therapy

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NEUROCOGNITIVE PROBLEMS IN ANTI-RETROVIRAL THERAPY. 6

and neurological impairment levels, the study examines the trend among patients with different

exposures to neuropsychological impairment and studies the progression rate among them.

Robertson KR et al. The prevalence and incidence of neurocognitive impairment in the

HAART era. AIDS 21: 1915 – 1921, 2007

Robertson studies the prevalence and incidence of neurocognitive impairment in the era

of human antiretroviral therapy. As a specialist in medical health, neurology, and AIDS research,

his findings are dependable. He notes that the impact of antiretroviral therapy on neurology are

less understood giving room for research in that area of HIV treatment. The study finds a

correlation between immunosuppression as a result of antiretroviral therapy and an increase in

neurocognitive impairment among HIV patients. This gives credence to the conclusion that

antiretroviral therapy causes neurological impairment, which validates the aim of this study. An

important conclusion from the study is the observation that antiretroviral therapy leads to a

sustained damage to the neurocognitive capacity.

Cysique L.A., & Brew B. J., (2009). Neuropsychological functioning and antiretroviral

treatment in HIV/AIDS: a review. Neuropsychol Rev. 2009; 19:169–185.

Lucette Cysique is a specialist in brain sciences at the University of New South Wales’

Department of Neurology. This background provides her with the academic knowledge of how

the brain is coordinated with the neurological system. In this study, she provides a review of

previous studies on the neuropsychological results of antiretroviral therapy among HIV-1

patients. The review acknowledges the persistence of neurocognitive impairments despite the

success of antiretroviral therapy at suppressing the virus. They provide a number of possible

causes for the sustained prevalence of neurocognitive impairment among HIV patients. This

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study is relevant to the study as it acknowledges the inefficiency of antiretroviral therapy in as

far as neurocognitive problems are concerned.

Ghate, M., Mehendale, S., Meyer, R., Umlauf, A., Deutsch, R., Kamat, R., Marcotte, T.

(2015). The effects of anti-retroviral treatment initiation on cognition in HIV-infected

individuals with advanced disease in Pune, India. Journal of Neurovirology, 21(4), 391–398.

All the contributors to this article have a background in AIDS research, epidemiology,

and neurobehavioral research either in India or the United States. The researchers note that

whereas severe cases of neurocognitive impairments have significantly been reduced over time,

there remain a huge number of mild neurocognitive impairments that remain unattended to. The

study is set in India, where the effect of HIV-1 is massively prevalent. The focus of the study is

in finding the impact of antiretroviral therapy on HIV-1 patients and the relationship between

their response to antiretroviral therapy and their neurocognitive performance. Most importantly,

the researchers determine the correlation between neurocognitive performance and CD4 count,

the measure of the effectiveness of antiretroviral therapy.

Kenedi, C. A., & Goforth, H. W. (2011). A systematic review of the psychiatric side-effects

of Efavirenz. AIDS and Behavior, 15(8), 1803-1818.

In this study, Christopher Kenedi and Harold Goforth examine the psychiatric side-effects

of Efavirenz, the leading antiretroviral therapy against HIV-1. The researchers begin by noting

that efavirenz is not recommended for patients with a history of mental illness, despite its being

recommended as a suitable defense against HIV virus multiplication. They examine data

regarding neurocognitive impairment among patients under this antiretroviral therapy. They find

a high correlation between neurocognitive impairment and sustained use of efavirenz.

Additionally, they also note the progression rate of neurocognitive impairment from the time of

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NEUROCOGNITIVE PROBLEMS IN ANTI-RETROVIRAL THERAPY. 8

initial use of the therapy, noting that there are higher chances of the patient progressing to an

acute case of the neurocognitive disease. The results of this study confirm that neurocognitive

diseases exist among HIV patients under ART, which can escalate over time.

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