HIV patients face new reality

Cognitive impairments could now be linked to years of living with this virus.

From left to right: Lesley Fellows (Neurology), Nancy Mayo (Clinical Epidemiology), Marie-Josée Brouillette (Psychiatry), Lisa Koski (Neuropsychology)

Twenty-four years ago, Robert (not his real name) was infected with HIV. With the right combination of treatments he has been able to live a healthy life. However, a few years ago, Robert started to experience concentration and memory problems. Holding something and not remembering where he wanted to put it, or opening the fridge and not remembering why, are not uncommon events for this active 59-year old.

Robert is one of the participants in an innovative study conducted by the McGill University Health Centre (MUHC) and the Montreal Neurological Hospital and Institute - The Neuro that is assessing cognitive function in patients living with HIV. He decided to take part to help the cause and advance science. “I don’t know if my problems are related to age, the virus or something else,” he says. “But if I can help, I will.”

The New Face of HIV

Thanks to the availability of highly effective antiretroviral therapy (HAART), deaths from AIDS plummeted by over 90%. per cent after 1995. The face of HIV seemed to change overnight. Today, people infected with HIV are now living into old age, but as a result secondary health problems are surfacing, such as possible cognitive decline.

“At the beginning of this epidemic, people with HIV had to stay home from work because they were sick,” says Dr. Marie-Josée Brouillette, a psychiatrist and researcher at the Research Institute of the MUHC, who is spearheading this project with her colleague Dr. Lesley Fellows, clinician-scientist at The Neuro. “Thirty years later, a problem now is they want to continue their professional lives, but if there are issues with concentration this can lead them to feel less effective mentally.”

In partnership with Clinique médicale l’Actuel, the study’s multidisciplinary team— composed of psychiatrists, neurologists, neuropsychologMsts, epidemiologists and HIV physicians—is currently developing a new tool to measure cognitive abilities in patients infected with HIV. the goal is to develop a battery of computerized tests that are free and remotely accessible, and that can reliably measure cognitive ability in just a few minutes.

“Our statistical analysis method (called a Rasch analysis) is a clinical epidemiology model, which in this case represents an innovative approach,” says Dr. Brouillette. “We are shedding new light on the relationship between cognitive symptom complaints and test results.”

The research project involves approximately 100 patients, who go to either Clinique médicale l’Actuel or the MUHC to take a series of online tests, which they take again three and six months later. Cmany studies have documented that between 30 and 50 per cent of people living with hIV have mild cognitive impairments,” says dr. Brouillette. “these impairments manifest as problems with attention, concentration and memory.”

Finding avenues for treatment

According to Dr. Brouillette, some patients get the HIV virus in their brains in spite of good viral control as measured in the blood, and these people may experience cognitive losses. The only test that can screen for HIV in the brain, currently, is a lumbar puncture—a procedure that is quite invasive and not appropriate in all cases.

“An outcome of this study is we may be able to measure cognitive decline that could suggest presence of the virus in the brain,” says Dr. Brouillette. “The challenge for researchers is to develop a battery of reliable tests that are easy to administer to larger cohorts of study participants so that scientists can expand their knowledge in this emerging field and can potentially identify interventions that could mitigate the negative impact of the virus on patients’ cognitive ability, earlier rather than later.”

This project is a collaboration between Marie-Josée Brouillette and Gail Myhr (Psychiatry); Lesley Fellows et Etienne de Villers-Sidani (Neurology); Nancy Mayo, Susan Bartlett and Nandini Dandukuri (Clinical Epidemiology); Lisa Koski, Alain Ptito and Maxim Lewkowski (Neuropsychology); Marina Klein and Jean-Pierre Routy (MUHC's Chronic Viral Illness Service); and Réjean Thomas and Benoit Trottier (Clinique médicale l’Actuel). With the support of Warren Steiner, MUHC Psychiatrist (MUHC Psychiatrist-in-chief when the project was initiated), Richard Lalonde, Director of Research, and Norbert Gilmore, Medical Director of the Chronic Viral Illness Service.