The Cognitive Remediation of Attention in HIV Associated Disorders (HAND): A Meta-Analysis and Systematic Review v1

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Objective: Despite medical advances in Highly Active Antiretroviral Therapy (HAART), patients living with HIV continue to be at risk for developing HIV-associated neurocognitive disorders (HAND) due to the virus’ effect on neuronal function. The optimization of non-HAART interventions, including cognitive rehabilitation therapy (CRT), shows promise in reversing the impact of HAND. However, no data indicate CRT's efficacy in remediating attention skills following HIV infection.This paper presents a meta-analysis of randomised and non-randomised controlled trials (RCTs) to remediate attention skills following HIV cognitive rehabilitation therapy. Method: Pre- and post-intervention data based on standardised mean differences (SMD) was calculated using a random effects model. Subgroup analyses of relevant moderator variables associated with outcomes in CRT were conducted, and publication bias was assessed. The study followed the PRISMA reporting guidelines for meta-analyses and was registered on Protocols.io. Results: Fourteen studies met the inclusion criteria (n = 532). There were significant pre- to post-intervention between-group benefits due to CRT in the experimental group relative to control conditions for the remediation of attention skills following HIV infection (Hedges g = 0.251, 95% CI = 0.005 to 0.497; p < 0.05). No significant effects (p > 0.05) were demonstrated for subgroup analysis. Conclusions: To the author's knowledge, this is the first meta-analysis that exclusively analyses the remediation of attention skills in the era of HAART and neuroHIV, where all studies included participants diagnosed with HIV. The overall meta-analysis effect indicates the efficacy of CRT in remediating attention skills in HIV and HAND. It is recommended that future cognitive rehabilitation protocols to remediate attention skills should be context and population-specific and that they be supplemented by objective biomarkers indicating the efficacy of the CRT.

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