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


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.)

Corresponding author
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:
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Albert, S.M., Marder, K., Dooneief, G., Bell, K., Sano, M., Todak, G., & Stern, Y. (1995). Neuropsychologic impairment in early HIV infection. A risk factor for work disability. Archives of Neurology, 52, 525530.

Carter, S.L., Rourke, S.B., Murji, S., Shore, D., & Rourke, B.P. (2003). Cognitive complaints, depression, medical symptoms, and their association with neuropsychological functioning in HIV infection: A structural equation model analysis. Neuropsychology, 17, 410419.

Chan, A.S., Shum, D., & Cheung, R.W. (2003). Recent development of cognitive and neuropsychological assessment in Asian countries. Psychological Assessment, 15, 257267.

Cysique, L.A.J., Deutsch, R., Atkinson, H.J., Young, C., Marcotte, T.D., Dawson, L., Grant, I., & Heaton, R.K. (2007). Incident major depression does not affect neuropsychological functioning in HIV infected men. Journal of the International Neuropsychological Society, 13, 111.

Cysique, L.A.J., Maruff, P., & Brew, B.J. (2006). The neuropsychological profile of symptomatic AIDS and ADC patients in the pre–highly active antiretroviral therapy era: A meta-analysis. Journal of the International Neuropsychological Society, 12, 368382.

d'Arminio Monforte, A., Testa, L., Adorni, F., Chiesa, E., Bini, T., Moscatelli, G.C., Abeli, C., Rusconi, S., Sollima, S., Balotta, C., Musicco, M., Galli, M., & Moroni, M. (1998). Clinical outcome and predictive factors of failure of highly active antiretroviral therapy in antiretroviral-experienced patients in advanced stages of HIV-1 infection. AIDS, 12, 16311637.

Diehr, M.C., Heaton, R.K., & Miller, W. (1998). The paced auditory serial addition task (PASAT): Norms for age, education, and ethnicity. Assessment, 5, 375387.

Ellis, R.J., Deutsch, R., Heaton, R.K., Marcotte, T.D., McCutchan, J.A., Nelson, J.A., Abramson, I., Thal, L.J., Atkinson, J.H., Wallace, M.R., & Grant, I. (1997). Neurocognitive impairment is an independent risk factor for death in HIV infection. San Diego HIV Neurobehavioral Research Center group. Archives of Neurology, 54, 416424.

Everall, I.P., Heaton, R.K., Marcotte, T.D., Ellis, R.J., McCutchan, J.A., Atkinson, J.H., Grant, I., Mallory, M., & Masliah, E. (1999). Cortical synaptic density is reduced in mild to moderate human immunodeficiency virus neurocognitive disorder. HNRC group. HIV Neurobehavioral Research Center. Brain Pathology, 9, 209217.

Gladsjo, J.A., Schuman, C.C., & Evans, J.D. (1999). Norms for letter and category fluency: Demographic corrections for age, education, and ethnicity. Assessment, 6, 147178.

Gronwall, D.M. (1977). Paced auditory serial-addition task: A measure of recovery from concussion. Perceptual and Motor Skills, 44, 367373.

Heaton, R., Marcotte, T.D., Rivera Mindt, M., Sadek, J., Moore, D., Bentley, H., McCutchan, A.J., Reicks, C., & Grant, I. (2004a). The impact of HIV associated neuropsychological impairment on everyday functioning. Journal of the International Neuropsychological Society, 10, 317331.

Heaton, R.K., Velin, R.A., McCutchan, J.A., Gulevich, S.J., Atkinson, J.H., Wallace, M.R., Godfrey, H.P., Kirson, D.A., & Grant, I. (1994). Neuropsychological impairment in human immunodeficiency virus-infection: Implications for employment. HNRC group. HIV Neurobehavioral Research Center. Psychosomatic Medicine, 56, 817.

Hinkin, C.H., Hardy, D.J., Mason, K.I., Castellon, S.A., Durvasula, R.S., Lam, M.N., & Stefaniak, M. (2004). Medication adherence in HIV infected adults: Effect of patient age, cognitive status and substance. AIDS, 18(Suppl. 1), S19S25.

Jernigan, T.L., Archibald, S., Hesselink, J.R., Atkinson, J.H., Velin, R.A., McCutchan, J.A., Chandler, J.L., & Grant I. (1993). Magnetic resonance imaging morphometric analysis of cerebral volume loss in human immunodeficiency virus infection. The HNRC group. Archives of Neurology, 50, 250255.

Jin, H., Atkinson, H.J., Yu, X., Heaton, R.K., Shi, C., Marcotte, T.P., Young, C., Sadek, J., Wu, Z., & Grant, I. (2006). Depression and suicidality in HIV/AIDS in China. Journal of Affective Disorders, 94, 269275.

Maj, M., Satz, P., Janssen, R., Zaudig, R., Starace, F., D'Elia, L., Sughondhabirom, B., Mussa, M., Naber, D., Ndetei, D., Schulte, G., & Sartorius, N. (1994). WHO neuropsychiatric AIDS study, cross-sectional phase II. Archives of General Psychiatry, 51, 5161.

Masliah, E., Achim, C.L., Ge, N., DeTeresa, R., Terry, R.D., & Wiley, C.A. (1992). Spectrum of human immunodeficiency virus-associated neocortical damage. Annals of Neurology, 32, 321329.

Masliah, E., Heaton, R.K., Marcotte, T.D., Ellis, R.J., Wiley, C.A., Mallory, M., Achim, C.L., McCutchan, A.J., Nelson, J.A., Atkinson, H.J., & Grant, I. (1997). Dendritic injury is a pathological substrate for human immunodeficiency virus-related cognitive disorders. Annals of Neurology, 42, 963972.

Mayeux, R., Stern, Y., Tang, M.X., Todak, G., Marder, K., Sano, M., Richards, M., Stein, Z., Ehrhardt, A., & Gorman, J. (1993). Mortality risks in gay men with human immunodeficiency virus infection and cognitive impairment. Neurology, 43, 176182.

Moore, D.J., Masliah, E., Rippeth, J., Gonzalez, R., Carey, C.L., Cherner, M., Ellis, R.J., Achim, C.L., Marcotte, T.D., Heaton, R.K., & Grant, I. (2006). Cortical and subcortical neurodegeneration is associated with HIV neurocognitive impairment. AIDS, 20, 879887.

Navia, B.A., Cho, E.S., Petito, C.K., & Price, R.W. (1986). The AIDS Dementia Complex: II neuropathology. Annals of Neurology, 19, 525535.

Piatt, A.L., Fields, J.A., Paolo, A.M., Koller, W.C., & Tröster, A.I. (1999). Lexical, semantic, and action verbal fluency in Parkinson's disease with and without dementia. Journal of Clinical and Experimental Neuropsychology, 21, 435443.

Reger, M., Wesh, R., Razani, J., Martin, D.J., & Boone, K.B. (2002). A meta-analysis of the neuropsychological sequelae of HIV infection. Journal of the International Neuropsychological Society, 8, 410424.

Rourke, S.B., Halman, M.H., & Bassel, C. (1999). Neurocognitive complaints in HIV-infection and their relationship to depressive symptoms and neuropsychological functioning. Journal of Clinical and Experimental Neuropsychology, 21, 737756.

Stout, J.C., Ellis, R.J., Jernigan, T.L., Archibald, S.L., Abramson, I., Wolfson, T., McCutchan, J.A., Wallace, M.R., Atkinson, J.H., & Grant, I. (1998). Progressive cerebral volume loss in human immunodeficiency virus infection: A longitudinal volumetric magnetic resonance imaging study. Archives of Neurology, 55, 161168.

Yepthomi, T., Paul, R., Vallabhaneni, S., Kumarasamy, N., Tate, D.F., Solomon, S., & Flanigan, T. (2006). Neurocognitive consequences of HIV in southern India: A preliminary study of clade c virus. Journal of the International Neuropsychological Society, 12, 424430.

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Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
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