The relationship between potentially traumatic or stressful events, HIV infection and neurocognitive impairment (NCI): a systematic review of observational epidemiological studies

摘要

Background: HIV/AIDS and potentially traumatic events (PTEs) or stressful life events (SLEs)and/or PTSD are independently associated with neurocognitive impairment (NCI). Literaturesuggests that HIV and PTE/SLE exposure independently and consistently affect variousdomains of cognition including language ability, working memory and psychomotorspeed. There are limited data on the interaction between HIV infection and PTEs and theircombined effect on NCI.Objective: In this systematic review, we synthesise evidence for the combined effect of HIVinfection and PTEs and SLEs and/or post-traumatic stress disorder (PTSD) on NCI of peopleliving with HIV/AIDS (PLWHA) from high-, middle- and low- income countries.Method: Our inclusion criteria were observational epidemiological studies (case-control,cohort and cross-sectional designs) that investigated the interaction of HIV infection, PTEsand SLEs and/or PTSD and specifically their combined effect on NCI in adults. We searcheda number of electronic databases including Pubmed/Medline, PsycINFO, Scopus and GlobalHealth using the search terms: cognition, HIV/AIDS, observational studies, trauma andpermutations thereof.Results: Fifteen studies were included in the review, of which the majority were conducted inhigh-income countries. Ten of the fifteen studies were conducted in the United States ofAmerica (USA) and five in South Africa. Seven of these focused on early life stress/childhoodtrauma. The remaining studies assessed adult-onset PTEs and SLEs only. Eight studies includedwomen only. Overall, the studies suggest that PTE and SLE exposure and/or PTSD area significant risk factor for NCI in adults living with HIV, with impairments in memory andexecutive functions being the most likely consequence of PTE and SLE exposure.Conclusion: These findings highlight the need for trauma screening and for the integrationof trauma-focused interventions in HIV care to improve outcomes.