Photo by Bruce Gilbert
Research conducted by a Fordham neuropsychologist shows that HIV may be affecting the cognitive deterioration of Latinos in New York City more severely than Latinos elsewhere.
Monica Rivera Mindt, Ph.D., assistant professor of psychology, is a co-investigator on an eight-year study, funded by the National Institute of Mental Health (NIMH), designed to gauge how HIV is affecting the long-term brain processes of Latinos on anti-retroviral drugs.
The sample of 1,556 HIV-positive patients from six locations across the nation has thus far produced some surprising results.
Initially, much of the HIV/AIDS research focused on the disease’s effect on patients’ immune function, despite the virus’ equally negative effect on their brain function, Rivera Mindt explained.
The advent of combined anti-retroviral therapies (CART) in the mid-1990s have significantly helped extend the lives of HIV-positive individuals. But according to the study, HIV’s effect on the brain is unchanged despite CART, and is becoming more noticeable thanks to patients’ longer lives.
“You can have HIV replicating in your brain uncontrollably even though you look perfectly healthy outside,” Rivera Mindt said.
Additionally, symptoms of cognitive deterioration, such as dementia, were more pronounced in New York Latinos.
“Of all HIV-positive populations across the country, Latinos in New York City appear to be the most cognitively impaired demographic in the whole consortium,” she said.
These results run counter to the encouraging outlook on the HIV/AIDS epidemic that has taken hold since the advent of CART. While the general public has stepped down from the panic that accompanied the discovery of the virus in the early 1980s, researchers fear that advances in HIV medications are being mistaken as a cure, when there remains much work to be done.
“When the anti-retroviral therapies improved, people started living longer,” Rivera Mindt said. “But you generally only get that outcome when you take your medications religiously.”
So why did Latinos from the New York City region fare worse than their counterparts in other areas, including Galveston, Texas and San Diego, Calif.?
Rivera Mindt said there are many possible explanations, including genetic differences between subpopulations and potential bias in the research process. However, she suspects that an even more plausible explanation is that there may be problems with how New York Latinos are taking their anti-retroviral medications.
Last October, Rivera Mindt received an almost $1 million grant from the NIMH to identify potential cognitive and sociocultural barriers that may interfere with the ability of HIV-positive Latinos in New York City to adhere to their medication regimens.
“We’re taking a look at cognitive factors, like problems with learning and memory,” she said. “We’re also looking at the socio-cultural factors, like acculturation, health beliefs and language barriers.”
Participants in Rivera Mindt’s study thus far have been recruited from Mount Sinai Hospital in Manhattan. The grant will allow her and her assistants to recruit from parts of Harlem and the surrounding area by collaborating with community organizations.
“I’m putting in sweat equity with the community by providing neuropsychological evaluations pro bono and working with the community on various initiatives,” she said. “Once we start getting results, I’ll communicate those results back to patients and their communities so they can benefit from their participation.”
Rivera Mindt said she initially became interested in investigating adherence by watching how her mother took routine antibiotics.
“She would try to ‘save’ them rather than take them as prescribed. That’s bad,” Rivera Mindt said. “So here we are talking about a population [of Latinos]that is having health problems because of HIV and might not have a lot of support—there are all kinds of challenges that might make it harder to adhere to meds regularly.
“Our preliminary research shows that HIV-positive Latinos are significantly less adherent compared to non-Hispanic whites,” she added.
So far, the failure to adhere to the regimens does not appear related to access to medication, since the study participants are often receiving the drugs from Mount Sinai. But that could change as the study ventures outside of the community.
Rivera Mindt is resolved to make a difference in a community that is growing by leaps and bounds.
“Here we have people disproportionately impacted by the HIV/AIDS epidemic, having worse outcomes once they get sick and nobody has really looked at why,” she said. “Latinos are the largest minority and they’re going to be 25 percent of the United States population by 2050. There are major public health implications for what is going on with this population.”
Rivera Mindt hasn’t found language to be a major factor impeding the adherence of anti-retroviral therapy within her patient population.
“It’s still early, but it’s looking like this population is highly acculturated and English language dominant,” she said of the study sample, which includes many American-born, Caribbean New Yorkers. “Part of the problem might be more of a health literacy issue. They may be having difficulties understanding prescriptions or how the medical system works.”
The larger part of Rivera Mindt’s research, she explained, “is dedicated to NeuroAIDS and reducing health disparities among Latinos to improve their long-term health and mental health outcomes.”
In the end, she would like to develop “culturally tailored interventions” that will bring Latino health statistics more in line with the general population. “My goal is for this work to ultimately reduce health disparities, as well as inform policy and interventions on a large scale. That’s my hope.”
