Nature and vocational significance of neuropsychological impairment associated with HIV infection

Research is described that addresses the nature and consequences of neuropsychological (NP) impairment associated with HIV infection. Results suggest increasing rates of NP impairment at each successive stage of infection (asymptomatic, mildly symptomatic, AIDS). NP deficits are related to independent evidence of abnormal brain structure and function, and are not explained by medical or psychiatric confounds. The NP impairment is ''spotty'' across infected persons, but is most frequently observed on tests of attention/speed of information processing and learning efficiency. Clinical and research assessments of HIV infected persons should especially focus on putative ''subcortical'' abilities, but maximum sensitivity requires coverage of multiple ability domains. NP impairment in this population also is associated with increased unemployment, complaints of job performance difficulties, and worse performance on standardized work samples. Interference with vocational functioning and general life quality may reflect considerable clinical importance of even subtle brain involvement in HIV infection.