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A multimodal assessment of driving performance in HIV infection

From the Departments of Psychiatry (Drs. Marcotte, Heaton, and Grant), Family and Preventive Medicine (T. Wolfson), and Neurosciences (Dr. Ellis), University of California, San Diego, and San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology (R. Gonzalez), and Systems Technology, Inc. (T.J. Rosenthal), Hawthorne, CA.

Address correspondence and reprint requests to Dr. T.D. Marcotte, HIV Neurobehavioral Research Center, 150 W. Washington, 2nd fl., San Diego, CA 92119; e-mail: tmarcotte{at}ucsd.edu

Objective: To examine if HIV-seropositive (HIV+) individuals are at risk for impaired driving.

Methods: Sixty licensed drivers (40 HIV+, 20 HIV–) completed a neuropsychological (NP) test battery and driving assessments. Eleven HIV+ subjects were NP-impaired. Driving-related skills were assessed using 1) two driving simulations (examining accident avoidance and navigational abilities), 2) the Useful Field of View (UFOV) test, and 3) an on-road evaluation.

Results: HIV+ NP-impaired subjects had greater difficulty than cognitively intact subjects on all driving measures, whereas the HIV– and HIV+ NP-normal groups performed similarly. On the UFOV, the HIV+ NP-impaired group had worse performance on Visual Processing and Divided Attention tasks but not in overall risk classification. They also had a higher number of simulator accidents (1.3 vs 2.0; p = 0.03), were less efficient at completing the navigation task (3.2 vs 9.2 blocks; p = 0.001), and were more likely to fail the on-road evaluation (6 vs 36%; p = 0.02). Impairment in Executive Functioning was the strongest NP predictor of failing the on-road drive test. NP performance and both simulations independently contributed to a model predicting 48% of the variance in on-road performance.

Conclusion: HIV+ NP-impaired individuals are at increased risk for on-road driving impairments, whereas HIV+ individuals with normal cognition are not at a significantly higher risk than HIV– subjects. Executive Functioning is most strongly associated with impaired on-road performance. Cognitive and simulator testing may each provide data in identifying driving-impaired individuals.

Received February 11, 2004. Accepted in final form June 15, 2004.

*See the Appendix on page 1422 for a list of Group Members.

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

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