Journal of the International Neuropsychological Society



Neurobehavioral effects of HIV-1 infection in China and the United States: A pilot study


LUCETTE A.  CYSIQUE  a1 , HUA  JIN  a1 a2 , DONALD R.  FRANKLIN  JR. a1 , ERIN E.  MORGAN  a1 , CHUAN  SHI  a3 , XIN  YU  a3 , ZUNYOU  WU  a4 , MICHAEL J.  TAYLOR  a1 , THOMAS D.  MARCOTTE  a1 , SCOTT  LETENDRE  a1 , CHRISTOPHER  AKE  a1 , IGOR  GRANT  a1 , ROBERT K.  HEATON  a1 a2 c1 and THE HNRC GROUP
a1 Department of Psychiatry, University of California at San Diego, San Diego, California
a2 VA San Diego Health Care System, San Diego, California
a3 Institute of Mental Health, Peking University, Beijing, China
a4 National Center for AIDS/STD Control & Prevention (NCAIDS), Peking University, Beijing, China

Article author query
cysique la   [PubMed][Google Scholar] 
jin h   [PubMed][Google Scholar] 
franklin dr   [PubMed][Google Scholar] 
morgan ee   [PubMed][Google Scholar] 
shi c   [PubMed][Google Scholar] 
yu x   [PubMed][Google Scholar] 
wu z   [PubMed][Google Scholar] 
taylor mj   [PubMed][Google Scholar] 
marcotte td   [PubMed][Google Scholar] 
letendre s   [PubMed][Google Scholar] 
ake c   [PubMed][Google Scholar] 
grant i   [PubMed][Google Scholar] 
heaton rk   [PubMed][Google Scholar] 

Abstract

The HIV epidemic in China has been increasing exponentially, yet there have been no studies of the neurobehavioral effects of HIV infection in that country. Most neuroAIDS research has been conducted in Western countries using Western neuropsychological (NP) methods, and it is unclear whether these testing methods are appropriate for use in China. Twenty-eight HIV seropositive (HIV+) and twenty-three HIV seronegative (HIV−) individuals with comparable gender, age, and education distributions were recruited in Beijing and the rural Anhui province in China. Thirty-nine HIV+ and thirty-one HIV− individuals were selected from a larger U.S. cohort recruited at the HIV Neurobehavioral Research Center, in San Diego, to be matched to the Chinese sample for age, disease status, and treatment variables. The NP test battery used with the U.S. and China cohorts included instruments widely used to study HIV infection in the United States. It consisted of 14 individual test measures, each assigned to one of seven ability areas thought to be especially vulnerable to effects of HIV on the brain (i.e., verbal fluency, abstraction/executive function, speed of information processing, working memory, learning, delayed recall, and motor function). To explore the cross-cultural equivalence and validity of the NP measures, we compared our Chinese and U.S. samples on the individual tests, as well as mean scaled scores for the total battery and seven ability domains. On each NP test measure, the mean of the Chinese HIV+ group was worse than that of the HIV− group. A series of 2 × 2 analyses of variance involving HIV+ and HIV− groups from both countries revealed highly significant HIV effects on the Global and all Domain mean scaled scores. Country effects appeared on two of the individual ability areas, at least partly due to education differences between the two countries. Importantly, the absence of HIV-by-Country interactions suggests that the NP effects of HIV are similar in the two countries. The NP test battery that was chosen and adapted for use in this study of HIV in China appears to have good cross-cultural equivalence, but appropriate Chinese norms will be needed to identify disease-related impairment in individual Chinese people. To inform the development of such norms, a much larger study of demographic effects will be needed, especially considering the wide range of education in that country. (JINS, 2007, 13, 781–790.)

(Received October 23 2006)
(Revised March 8 2007)
(Accepted March 8 2007)


Key Words: HIV/AIDS; Neuropsychological functioning; Cognition; China; Cross-cultural assessment; Everyday functioning.

Correspondence:
c1 Correspondence and reprint requests to: Robert K. Heaton, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive #0603, La Jolla, California 92093-0603, USA. E-mail: rheaton@ucsd.edu