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Apathy Correlates With Cognitive Function But Not CD4 Status in Patients With Human Immunodeficiency Virus

Received August 21, 2002; revised June 9, 2003; accepted June 12, 2003. From Brown Medical School, Department of Psychiatry and Human Behavior; Brown Medical School, Department of Infectious Disease; and the University of California Los Angeles School of Medicine, Department of Neuropsychiatry. Address correspondence to Dr. Paul, Brown Medical School, Center for AIDS Research & Centers for Behavioral and Preventive Medicine, 1 Hoppin Street, Providence, RI 02903; RPaul{at}Lifespan.org (E-mail).

ABSTRACT

Apathy is a prominent neuropsychiatric symptom associated with human immunodeficiency virus (HIV). The increased frequency of apathy in this population may reflect the direct involvement of the virus on the central nervous system (CNS), but the severity of apathy has not been shown to consistently relate to markers of disease activity or other neuropsychiatric complications of the virus. We examined the relationship between ratings of apathy and performance on measures of cognitive function and immune system status in a sample of HIV-infected patients. Apathy was significantly elevated among HIV-infected individuals compared to healthy comparison subjects. Apathy was significantly related to performance on measures of learning efficiency and a measure of cognitive flexibility. Ratings of apathy did not relate to CD4 cell count, but they were associated with disease duration. In addition, ratings of depression were independent of ratings of apathy. These findings suggest that apathy does not co-vary with a proxy measure of active disease status, but apathy does relate to several measures of cognitive dysfunction in patients with HIV. As such, the increased prevalence of apathy among HIV-infected adults may reflect HIV-associated neurologic dysfunction.

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