Cognitive function and drivers of cognitive impairment in a European and a Korean cohort of people living with HIV

Although cognitive impairments are still prevalent in the current antiretroviral therapy era, limited investigations have compared the prevalence of cognitive disorder in people living with HIV (PLWH) and its determinants in different regions and ethnicities. We compared cognitive performance across six domains using comparable batteries in 134 PLWH aged ≥45 years from the COBRA study (Netherlands, UK), and 194 PLWH aged ≥18 years from the NeuroAIDS Project (South Korea). Cognitive scores were standardized and averaged to obtain domain and global T-scores. Associations with global T-scores were evaluated using multivariable regression and the ability of individual tests to detect cognitive impairment (global T-score ≤45) was assessed using the area-under-the-receiver-operating-characteristic curve (AUROC). The median (interquartile range) age of participants was 56 (51, 62) years in COBRA (88% white ethnicity, 93% male) and 45 (37, 52) years in NeuroAIDS (100% Korean ethnicity, 94% male). The rate of cognitive impairment was 18.8% and 18.0%, respectively ( p = 0.86). In COBRA, Black-African ethnicity was the factor most strongly associated with cognitive function (11.1 [7.7, 14.5] lower scores vs. white ethnicity, p < 0.01), whereas in NeuroAIDS, age (0.6 [0.1, 1.3] per 10-year, p<0.01) and education (0.7 [0.5, 0.9] per year, p<0.01) were significantly associated with cognitive function with anemia showing only a weak association (−1.2 [−2.6, 0.3], p=0.12). Cognitive domains most associated with cognitive impairment were attention (AUROC = 0.86) and executive function (AUROC = 0.87) in COBRA and processing speed (AUROC = 0.80), motor function (AUROC = 0.78) and language (AUROC = 0.78) in NeuroAIDS. Two cohorts of PLWH from different geographical regions report similar rates of cognitive impairment but different risk factors and cognitive profiles of impairment.

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Quality of life in people living with HIV-associated neurocognitive disorder: A scoping review study

PLoS ONE ◽

10.1371/journal.pone.0251944 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251944

Author(s):

Kate Alford ◽

Stephanie Daley ◽

Sube Banerjee ◽

Jaime H. Vera

Keyword(s):

Quality Of Life ◽

Cognitive Impairment ◽

Scoping Review ◽

Chronic Conditions ◽

Healthy Aging ◽

Cognitive Disorder ◽

World Health ◽

People Living With Hiv ◽

Living With Hiv

Quality of life (QoL) is recognized as an essential end point in the disease management of chronic conditions such as HIV with calls to include good QoL as a ‘fourth 90’ in the 90-90-90 testing and treatment targets introduced by World Health Organization in 2016. Cognitive impairments impact a broad spectrum of experiences and are a common issue effecting people living with HIV (PLWH). Despite this, few studies have examined QoL in PLWH who also have a cognitive disorder. This study aimed to synthesize and describe what is known about QoL in those living with HIV-associated neurocognitive disorders (HAND). A scoping review of peer-reviewed literature was conducted to identify how QoL has been investigated and measured in PLWH with HAND, and how PLWH with HAND report and describe their QoL. We searched PsychInfo, Medline, Scopus, and Web of Science along with hand-searching reference lists from relevant studies found. Included studies were those published in English after 1st January 2003 which included PLWH with cognitive impairment not due to other pre-existing conditions. Fifteen articles met criteria for inclusion. Two studies measured QoL as a primary aim, with others including QoL assessment as part of a broader battery of outcomes. The MOS-HIV and SF-36 were the most commonly used measures of overall QoL, with findings generally suggestive of poorer overall QoL in PLWH with HAND, compared to PLWH without cognitive impairment. Studies which examined dimensions of QoL focused exclusively on functionality, level of independence, and psychological QoL domains. There is a considerable dearth of research examining QoL in PLWH with HAND. The initiatives which advocate for healthy aging and improved QoL in PLWH must be extended to include and understand the experiences those also living with cognitive impairment. Research is needed to understand the broad experiential impacts of living with these two complex, chronic conditions, to ensure interventions are meaningful to patients and potential benefits are not missed.

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Prejudicial beliefs and COVID-19 disruptions among sexual minority men living with and not living with HIV in a high SARS-CoV-2 prevalence area

Translational Behavioral Medicine ◽

10.1093/tbm/ibab050 ◽

2021 ◽

Author(s):

Seth C Kalichman ◽

Renee El-Krab ◽

Bruno Shkembi ◽

Moira O Kalichman ◽

Lisa A Eaton

Keyword(s):

African American ◽

African American Men ◽

People Living With Hiv ◽

Sex Partners ◽

Black African ◽

Sexual Minority Men ◽

Mediation Analyses ◽

Personal Action ◽

Male Sex ◽

Living With Hiv

Abstract The COVID-19 pandemic has had profound health and social impacts. COVID-19 also affords opportunities to study the emergence of prejudice as a factor in taking protective actions. This study investigated the association of COVID-19 concerns, prejudicial beliefs, and personal actions that involve life disruptions among people not living with and people living with HIV. 338 Black/African American men not living with HIV who reported male sex partners and 148 Black/African American men living with HIV who reported male sex partners completed a confidential survey that measured COVID-19 concern, COVID-19 prejudice, and personal action and institutionally imposed COVID-19 disruptions. Participants reported having experienced multiple social and healthcare disruptions stemming from COVID-19, including reductions in social contacts, canceling medical appointments, and inability to access medications. Mediation analyses demonstrated that COVID-19 concerns and COVID-19 prejudice were associated with personal action disruptions, indicating that these social processes are important for understanding how individuals modified their lives in response to COVID-19. It is imperative that public health efforts combat COVID-19 prejudice as these beliefs undermine investments in developing healthcare infrastructure to address COVID-19 prevention.

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Obesity in the HIV-infected population in Northeast England: a particular issue in Black-African women

International Journal of STD & AIDS ◽

10.1177/0956462416649131 ◽

2016 ◽

Vol 28 (3) ◽

pp. 284-289 ◽

Cited By ~ 3

Author(s):

C Ilozue ◽

B Howe ◽

S Shaw ◽

K Haigh ◽

J Hussey ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Local Population ◽

African Women ◽

People Living With Hiv ◽

Black African ◽

Regional Population ◽

Living With Hiv

People living with HIV are surviving longer on successful antiretroviral therapy and obesity rates are increasing. We sought to determine the prevalence of being overweight or obese in a regional population of people living with HIV and to explore the demographic and clinical characteristics associated with obesity or being overweight. Data on patients attending three Northeast England clinics were collected including body mass index and demographics. The prevalence of being overweight (body mass index ≥ 25 kg/m2) or obese (body mass index ≥ 30 kg/m2) was determined and compared with regional population data. Associations between being overweight or obese and demographic and other data were further explored using logistic regression models. In 560 patients studied (median age 45 years, 26% Black-African and 69% male), 65% were overweight/obese and 26% obese, which is similar to the local population. However, 83% and 48% of Black-African women were overweight/obese or obese, respectively, with 11% being morbidly obese (body mass index > 40 kg/m2). In the multivariate analyses, the only factors significantly associated with obesity were Black-African race (adjusted odds ratio 2.78, 95% confidence interval 1.60–4.85) and type 2 diabetes (adjusted odds ratio 4.23, 95% confidence interval 1.81–9.91). Levels of obesity and overweight in people living with HIV are now comparable to the levels in the local population of Northeast England; however, the prevalence is significantly higher in Black-African women. Given the additional risk factors for cardiovascular disease inherent in people living with HIV, better strategies to prevent, identify and manage obesity in this population are needed.

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Cognitive Impairment Among Aging People Living With HIV on Antiretroviral Therapy

Journal of the Association of Nurses in AIDS Care ◽

10.1097/jnc.0000000000000122 ◽

2020 ◽

Vol 31 (3) ◽

pp. 301-311 ◽

Cited By ~ 1

Author(s):

Xueling Xiao ◽

Hui Zeng ◽

Caiyun Feng ◽

Hang Tan ◽

Lanlan Wu ◽

...

Keyword(s):

Cognitive Impairment ◽

Antiretroviral Therapy ◽

People Living With Hiv ◽

Living With Hiv ◽

Aging People

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The effects of a 16-week aerobic exercise programme on cognitive function in people living with HIV

AIDS Care ◽

10.1080/09540121.2016.1263723 ◽

2016 ◽

Vol 29 (6) ◽

pp. 667-674 ◽

Cited By ~ 17

Author(s):

Adam McDermott ◽

Lilia Zaporojan ◽

Patricia McNamara ◽

Colin P. Doherty ◽

Janice Redmond ◽

...

Keyword(s):

Cognitive Function ◽

Aerobic Exercise ◽

Exercise Programme ◽

People Living With Hiv ◽

Living With Hiv

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352. Characteristics Associated with Pre-Frailty in Older People Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.425 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S186-S186

Author(s):

Peter Mazonson ◽

Theoren Loo ◽

Jeff Berko ◽

Sarah-Marie Chan ◽

Ryan Westergaard ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cognitive Function ◽

Older People ◽

Logistic Regression Analysis ◽

The United States ◽

People Living With Hiv ◽

Factors Associated ◽

Increased Risk ◽

Living With Hiv

Abstract Background Frailty is a concern among older people living with HIV (PLHIV). There is a paucity of research characterizing PLHIV who are at risk of becoming frail (pre-frailty). To investigate how HIV impacts older PLHIV in the United States, a new study called Aging with Dignity, Health, Optimism and Community (ADHOC) was launched at ten sites to collect self-reported data. This analysis uses data from ADHOC to identify factors associated with pre-frailty. Methods Pre-frailty was assessed using the Frailty Index for Elders (FIFE), where a score of zero indicated no frailty, 1–3 indicated pre-frailty, and 4–10 indicated frailty. A cross-sectional analysis was performed on 262 PLHIV (age 50+) to determine the association between pre-frailty and self-reported sociodemographic, health, and clinical indicators using bivariate analyses. Factors associated with pre-frailty were then included in a logistic regression analysis using backward selection. Results The average age of ADHOC participants was 59 years. Eighty-two percent were male, 66% were gay or lesbian, and 56% were white. Forty-seven percent were classified with pre-frailty, 26% with frailty, and 27% with no frailty. In bivariate analyses, pre-frailty was associated with depression, low cognitive function, depression, multiple comorbidities, low income, low social support and unemployment (Table 1). In the multiple logistic regression analysis, pre-frailty was associated with having low cognitive function (Odds Ratio [OR] 8.56, 95% Confidence Interval [CI]: 3.24–22.63), 4 or more comorbid conditions (OR 4.00, 95% CI: 2.23–7.06), and an income less than $50,000 (OR 2.70, 95% CI: 1.56–4.68) (Table 2). Conclusion This study shows that commonly collected clinical and sociodemographic metrics can help identify PLWH who are more likely to have pre-frailty. Early recognition of factors associated with pre-frailty among PLHIV may help to prevent progression to frailty. Understanding markers of increased risk for pre-frailty may help clinicians and health systems better target multi-modal interventions to prevent negative health outcomes associated with frailty. Disclosures All authors: No reported disclosures.

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Improved Central Nervous System Symptoms in People with HIV without Objective Neuropsychiatric Complaints Switching from Efavirenz to Rilpivirine Containing cART

Brain Sciences ◽

10.3390/brainsci9080195 ◽

2019 ◽

Vol 9 (8) ◽

pp. 195 ◽

Cited By ~ 1

Author(s):

Vera ◽

Bracchi ◽

Alagaratnam ◽

Lwanga ◽

Fox ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Tenofovir Disoproxil Fumarate ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

People Living With Hiv ◽

White Ethnicity ◽

Patient Reported ◽

Switching Therapy ◽

Living With Hiv

Objective: Occult central nervous system (CNS) symptoms not recognized by people living with HIV (PLWH) receiving efavirenz or their clinicians could occur and impact people’s quality of life. The aim of this study was to determine whether CNS parameters improve in PLWH when switching from efavirenz to rilpivirine. Methods: PLWH receiving tenofovir disoproxil fumarate, emtricitabine, efavirenz (Atripla™) with undetectable HIV RNA, and no CNS symptoms were switched cART to tenofovir disoproxil fumarate, emtricitabine, rilpivirine (Eviplera™). CNS parameters including sleep, anxiety, and depressive symptoms were evaluated using patient-reported outcome measures at baseline, 4, 12, and 24 weeks after switching therapy. A median CNS score was derived from the sum of CNS toxicities of all the grades collected in the study questionnaires. Cognitive function was assessed using a computerized test battery. Results: Of 41 participants, median age was 47 years, Interquartile range (IQR) 31, 92% were male and 80% were of white ethnicity. A significant reduction in total CNS score (10 to 7) was observed at 4 weeks (p = 0.028), but not thereafter. Significant improvements in sleep and anxiety were observed 4, 12 and 24 weeks after switching therapy (p < 0.05). No significant change in global cognitive scores was observed. Conclusions: Switching from efavirenz to rilpivirine based regimens in virologically suppressed PLWH without perceived CNS symptoms was well tolerated and slightly improved overall CNS symptoms.

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