Neurocognitive Rehabilitation for an Adolescent HIV Population: The Case of Sustained Attention

Abstract

The Human Immunodeficiency Virus (HIV) continues to be a significant disease burden. In terms of neurocognitive health, HIV crosses the blood-brain barrier, resulting in neuronal dysregulation and compromised neurocognition. Of further import, antiretroviral drugs are indicated to have limited permeability in the central nervous system and do not reverse compromised neurocognition, sequent HIV neuroinvasion. The objectives of the study were to investigate the efficacy of HIV cognitive rehabilitation therapy (HIV-CRT) in adolescent HIV. The first aim was to investigate the evidence for the cognitive rehabilitation of HIV in adolescent and geriatric samples, sequent neuroHIV. This investigation resulted in the publication of a meta-analysis detailing the efficacy of attention remediation in neuroHIV. The second aim was to examine the efficacy of fNIRS neuroimaging in measuring hemodynamic responses in the prefrontal cortex in adolescents neuroHIV. This investigation resulted in the publication of an article detailing the efficacy of fNIRS in detailing changes in oxygenated haemoglobin in adolescents living with neuroHIV. The third aim was to pair fNIRS optical neuroimaging with behavioural data to investigate changes associated with brain training at a cortical and behavioural level. The execution of the above aim resulted in the publication of an article detailing the procedures and methods to achieve the enquiry. The fourth article, under review, details findings related to neural efficiency and attention training. The final manuscript, under preparation, details functional connectivity outcomes related to attention training. To enable the analysis of the published articles, an initial cohort of 42 adolescents (mean age = 17.28) living with HIV participated in the study. Following attrition, the sample was reduced to 26 participants. Thirteen participants were assigned to the treatment group (n = 13; mean age = 16; SD = 1.2), which received cognitive rehabilitation to remediate attention. Thirteen children acted as controls (mean age = 17; SD = 1.3). Pre- and post-intervention data were analysed using behavioural and optical imaging data. 5 Findings indicated that HIV-CRT (attention) is associated with decreased oxygenated haemoglobin (HbO) and increased functional connectivity in the Central Executive Network (CEN). Contrary to expectation, HIV-CRT was associated with minimal behavioural gains, as indicated by neuropsychological assessments. Taken together, findings seem to suggest that in adolescent neuroHIV, customised HIV-CRT promotes cortical efficiency. However, brain training does not translate to immediate behavioural improvements at post-assessment. Summarily, findings suggest that cortical plasticity may precede near-and-far cognitive transfer gain in adolescents neuroHIV.