Whereas our cross sectional data have provided some valuable insight into the CNS deficits associated with HIV infection, longitudinal data are necessary to answer other pressing questions. For example, how early in the course of HIV infection can CNS dysfunction be detected, and does the mild neuropsychological impairment seen in some individuals represent the subclinical manifestation of incipient dementia? Future research needs not only to increase its focus on longitudinal designs but also take into account individuals' dates of seroconversion. Additionally, given the generally mild and patchy pattern of impairments seen in our neuropsychologically impaired HIV-positive individuals, attempts to detect CNS changes early in the course of the disease must utilize comprehensive assessments that measure numerous domains.
Although our results suggest some association between neuropsychological impairment and reported vocational difficulties in HIV-infected persons, much more research is needed to establish the relevance of mild neurocognitive deficits to everyday functioning. Such research should focus on medically asymptomatic or minimally symptomatic subjects to avoid the possible confounding effects of nonneurologic disease. In addition, effects of specific ability deficits on more specific everyday activities (including nonvocational activities) should be investigated. Finally, efforts should be made to obtain more objective data about adequacy of everyday performance. This might include direct observation of the subject's behavior by the investigators and/or obtaining confirmatory reports from other observers in the subject's natural environment (e.g., job supervisor, family member).
The San Diego HIV Neurobehavioral Research Center [HNRC] Group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the San Diego VA Medical Center and includes: Igor Grant, J. Hampton Atkinson, Robert A. Velin, Edward C. Oldfield III, James L. Chandler, Mark R. Wallace, Charles A. Kennedy, J. Allen McCutchan, Stephen A. Spector, Leon Thal, R obert K. Heaton, John Hesselink, Terry Jernigan, J. Hampton Atkinson, Clayton A. Wiley, Richard Olshen, Ian Abramson, Nelson Butters, Renée Dupont, Thomas Patterson, Sidney Zisook, Dilip Jeste, Hans Sieburg, and James D. Weinrich.
The principal support for the HNRC is provided by NIMH Center grant 5 P50 MH45294 ( HIV Neurobehavioral Research Center). Additional support is provided by 5 R01 MH43298 (Neuropsychiatric Sequelae of HTLV-III Infections), 5 R29 MH45688 (Object-Oriented Simulation of HIV and CNS/HIV Infection), R01 MH46255 (Psychosocial Moderators of Disease Progression in AIDS), 1