HIV This Week

Van Gorp WG, Rabkin JG, Ferrando SJ, Mintz J, Ryan E, Borkowski T, McElhiney M. Neuropsychiatric predictors of return to work in HIV/AIDS. J Int Neuropsychol Soc 2007;13:80-9.

Van Gorp and colleagues followed 118 HIV+ individuals who had taken steps to return to work to determine facilitators or barriers in returning to work. Over the two-year study period, 52% of the participants obtained employment. Memory function served as the most potent predictor of obtaining employment. Persons who were younger, did not have a diagnosis of AIDS and who had shorter periods of unemployment prior to entering the study also had better chances of finding employment during the study. After finding employment, participants reported lower levels of depression as well, an apparent result of their obtaining employment. The authors conclude that these findings indicate that memory is a key neuropsychiatric variable that is perhaps most relevant to HIV+ persons' quest to return to work.

Editors’ note: This study begs the question of the link between unemployment, depression and memory problems – and where best to focus attention – perhaps on all three.

Iudicello JE, Woods SP, Parsons TD, Moran LM, Carey CL, Grant I. Verbal fluency in HIV infection: A meta-analytic review. J Int Neuropsychol Soc 2007;13:183-189.

Given the largely prefrontostriatal neuropathogenesis of HIV-associated neurobehavioural deficits, it is often presumed that HIV infection leads to greater impairment on letter versus category fluency. Iudicello and colleagues conducted a meta-analysis of the HIV verbal fluency literature (k = 37, n = 7110) to assess this hypothesis and revealed generally small effect sizes for both letter and category fluency, which increased in magnitude with advancing HIV disease severity. Across all studies, the mean effect size of category fluency was slightly larger than that of letter fluency. However, the discrepancy between category and letter fluency dissipated in a more conservative analysis of only those studies that included both tests. Thus, HIV-associated impairments in letter and category fluency are of similar magnitude, suggesting that mild word generation deficits are evident in HIV, regardless of whether traditional letter or semantic cues are used to guide the word search and retrieval process.

Editors’ note: Those of us who have not studied the determinants and categories of linguistic fluency will not understand the meaning of this finding of no significant differences in letter and category fluency - but we can retain the importance of allowing people living with HIV who are having difficulty finding a word a little more time to do so.