Depressive symptoms and level of physical activity mediate the associations between HIV sero-status and neurocognitive functions among individuals aged at least 50 years in China (Preprint)

BACKGROUND Neurocognitive impairment are prevalent among older people. It is more problematic among older people living with HIV (PLWH). This study was to explore whether the association between HIV sero-status and neurocognitive performance was mediated by depressive symptoms and/or level of physical activity. OBJECTIVE Neurocognitive impairment are prevalent among older people in China. It is more problematic among older people living with HIV (PLWH). This study was to compare neurocognitive performance between older PLWH and HIV-negative controls, and to explore whether the association between HIV sero-status and neurocognitive performance was mediated by depressive symptoms and/or level of physical activity. METHODS A cross-sectional study was conducted in Yongzhou, China. All PLWH aged ≥50 years listed in the registry were invited. Frequency matching was used to sample HIV-negative controls according to the distribution of age, sex, and years of formal education of older PLWH. A total of 315 older PLWH and 350 HIV-negative controls completed the face-to-face interview and comprehensive neuropsychological assessment of seven domains (learning, memory, working memory, verbal fluency, processing speed, executive function and motor skills). RESULTS As compared to HIV-negative controls, older PLWH performed worse in global score and all seven domains (P<.05). Positive HIV sero-status was associated with higher depressive symptoms (P<.001) and lower level of physical activity (P<.001). Depressive symptoms and physical activity were negatively correlated (P<.001). Depressive symptoms and/or level of physical activity mediated the association between HIV sero-status and global score and four domain-specific neurocognitive performance (learning, memory, verbal fluency, and processing speed). CONCLUSIONS Change in mental health and physical activity after HIV infection may partially explain why older PLWH are more susceptible to neurocognitive impairment. Promoting mental health and physical activity are potential entry points to slow down the progress of neurocognitive impairment among older PLWH.

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Depressive Symptoms Differentially Predict Neurocognition in Latinx and Non-Hispanic White People Living with HIV

Journal of the International Neuropsychological Society ◽

10.1017/s1355617720000855 ◽

2020 ◽

pp. 1-12

Author(s):

Emily P. Morris ◽

Desiree Byrd ◽

Angela C. Summers ◽

Kayla Tureson ◽

Vanessa Guzman ◽

...

Keyword(s):

Depressive Symptoms ◽

Processing Speed ◽

Cross Sectional Study ◽

People Living With Hiv ◽

Neurocognitive Performance ◽

Cross Sectional ◽

Neurocognitive Dysfunction ◽

Affective Symptoms ◽

Living With Hiv ◽

Hispanic White

Abstract Objectives: Depression is common in people living with HIV (PLWH) and can contribute to neurocognitive dysfunction. Depressive symptoms in PLWH are often measured by assessing only cognitive/affective symptoms. Latinx adults, however, often express depressive symptoms in a somatic/functional manner, which is not typically captured in assessments of depression among PLWH. Given the disproportionate burden of HIV that Latinx adults face, examining whether variations in expressed depressive symptoms differentially predict neurocognitive outcomes between Latinx and non-Hispanic white PLWH is essential. Methods: This cross-sectional study included 140 PLWH (71% Latinx; 72% male; mean (M) age = 47.1 ± 8.5 years; M education = 12.6 ± 2.9 years) who completed a comprehensive neurocognitive battery, Wechsler Test of Adult Reading (WTAR), and Beck Depression Inventory-II (BDI-II). Neurocognitive performance was measured using demographically adjusted T-scores. BDI-II domain scores were computed for the Fast-Screen (cognitive/affective items) score (BDI-FS) and non-FS score (BDI-NFS; somatic/functional items). Results: Linear regressions revealed that the BDI-NFS significantly predicted global neurocognitive function and processing speed in the Latinx group (p < .05), such that higher physical/functional symptoms predicted worse performance. In the non-Hispanic white group, the cognitive/affective symptoms significantly predicted processing speed (p = .02), with more symptoms predicting better performance. Interaction terms of ethnicity and each BDI sub-score indicated that Latinx participants with higher cognitive/affective symptoms performed worse on executive functioning. Conclusions: Depressive symptoms differentially predict neurocognitive performance in Latinx and non-Hispanic white PLWH. These differences should be considered when conducting research and intervention among the increasingly culturally and ethnically diverse population of PLWH.

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Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2020-041734 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041734

Author(s):

Ni Gusti Ayu Nanditha ◽

Adrianna Paiero ◽

Hiwot M Tafessu ◽

Martin St-Jean ◽

Taylor McLinden ◽

...

Keyword(s):

British Columbia ◽

Cohort Study ◽

Population Based ◽

Age At Diagnosis ◽

Secondary Outcome ◽

People Living With Hiv ◽

Prevalence Trends ◽

Living With Hiv ◽

Negative Controls ◽

Hiv Negative

ObjectivesAs people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV.Design and settingThis population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada.ParticipantsThe study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012.Primary and secondary outcome measuresThe presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer’s and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters.ResultsAcross study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer’s and/or dementia.ConclusionsPLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.

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Psycho-behavioral factors associated with neurocognitive performance among people living with HIV on antiretroviral therapy in Accra, Ghana

African Health Sciences ◽

10.4314/ahs.v20i2.6 ◽

2020 ◽

Vol 20 (2) ◽

pp. 587-596

Author(s):

Nana Asiedu ◽

Irene Kretchy ◽

Emmanuel Asampong

Keyword(s):

Operating Characteristic ◽

Neurocognitive Impairment ◽

People Living With Hiv ◽

Neurocognitive Performance ◽

Factors Associated ◽

Non Invasive ◽

Hiv Management ◽

Behavioural Factors ◽

Living With Hiv ◽

Selection Of

Background: It is estimated that almost half of all people living with HIV have some form of neurocognitive impairment, but few studies have looked at the risk of neurocognitive impairment and its associated factors in Ghana, due in part to limited resources for such testing. Objective: To examine neurocognitive performance in a group of Ghanaians living with HIV and possible factors that contribute to their performance. Methods: One hundred and four patients were assessed using a selection of brief non-invasive neuropsychological assess- ments as well as the International HIV Dementia Scale. Psycho-behavioural factors (alcohol use, depression, and medication adherence) as well as demographic characteristics and functional daily activities were assessed to determine their association with neurocognitive performance, using linear regression and receiver operating characteristic analyses. Results: About 48% of the participants met the criteria for risk of neurocognitive impairment. Age, education, and symp- toms of depression were found to be significantly associated with the risk of impairment. Conclusion: Some people living with HIV showed risk of neurocognitive impairment, which was significantly associated with education, age and depressive symptoms. It is therefore important to consider routine neurocognitive screening in HIV management to recognize any risks for early interventions. Keywords: ART adherence; depression; neurologic disease.

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Cognitive function, depressive symptoms and syphilis in HIV-positive and HIV-negative individuals

International Journal of STD & AIDS ◽

10.1177/0956462418817612 ◽

2019 ◽

Vol 30 (5) ◽

pp. 440-446 ◽

Cited By ~ 2

Author(s):

Davide De Francesco ◽

Alan Winston ◽

Jonathan Underwood ◽

Fiona V Cresswell ◽

Jane Anderson ◽

...

Keyword(s):

Depressive Symptoms ◽

Cognitive Function ◽

Cognitive Test ◽

People Living With Hiv ◽

Serological Tests ◽

Syphilis Infection ◽

Patient Health ◽

History Of ◽

Negative Controls ◽

Hiv Negative

We evaluated associations between history of syphilis infection and both cognitive function and depressive symptoms in people living with HIV (PLHIV) and comparable HIV-negative controls. Syphilis serological tests, cognitive function and depression were assessed in PLHIV and controls participating in the Pharmacokinetic and Clinical Observations in People Over Fifty study. Cognitive test scores were converted to demographically adjusted T-scores (mean = 50, SD = 10) and then averaged to obtain a global T-score. Severity of depressive symptoms was assessed via the Patient Health Questionnaire-9. Associations of syphilis with global T-scores and depression were assessed using median regression. The 623 PLHIV and 246 HIV-negative controls were predominantly male (89.3% and 66.5%) with median age (interquartile range [IQR]) of 57 (53–63) and 58 (53–63) years, respectively. PLHIV had lower global cognitive T-scores (median [IQR] 48.7 [45.1, 52.1] versus 50.5 [47.0, 53.9], p < 0.001), more severe depressive symptoms (median [IQR] 4 [1, 10] versus 1 [0, 3], p < 0.001) and were more likely to report history of syphilis infection (22.0% versus 8.1%) than controls. There was no significant association between history of syphilis and global cognitive function in either PLHIV (p = 0.69) or controls (p = 0.10). Participants with a history of syphilis had more severe depressive symptoms (median [IQR] 4 [1, 9] versus 2 [0, 8], p = 0.03); however, the association became non-significant (p = 0.62) after adjusting for HIV status and potential confounders. Despite the higher prevalence of syphilis infection in PLHIV, there was no evidence of an association between history of syphilis infection and impaired cognitive function nor depressive symptoms after accounting for potential confounders.

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Depression, lifestyle factors and cognitive function in people living with HIV and comparable HIV-negative controls

HIV Medicine ◽

10.1111/hiv.12714 ◽

2019 ◽

Vol 20 (4) ◽

pp. 274-285 ◽

Cited By ~ 6

Author(s):

D De Francesco ◽

J Underwood ◽

E Bagkeris ◽

M Boffito ◽

FA Post ◽

...

Keyword(s):

Cognitive Function ◽

Lifestyle Factors ◽

People Living With Hiv ◽

Living With Hiv ◽

Negative Controls ◽

Hiv Negative

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Electrocardiographic and echocardiographic abnormalities in urban African people living with HIV in South Africa

PLoS ONE ◽

10.1371/journal.pone.0244742 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0244742

Author(s):

Geert V. T. Roozen ◽

Ruchika Meel ◽

Joyce Peper ◽

William D. F. Venter ◽

Roos E. Barth ◽

...

Keyword(s):

South Africa ◽

Viral Load ◽

Left Ventricular Mass ◽

Qt Interval ◽

Left Ventricular ◽

Hiv Positive ◽

People Living With Hiv ◽

Living With Hiv ◽

Negative Controls ◽

Hiv Negative

Background Studies from high income countries report that HIV-positive people have an impaired systolic and diastolic cardiac function compared to HIV-negative people. It is unclear if results can be translated directly to the Sub-Saharan Africa context. This study assesses electro- and echocardiographic characteristics in an urban African population, comparing HIV-positive people (treated and not yet treated) with HIV-negative controls. Methods We conducted a cross-sectional study in Johannesburg, South Africa. We enrolled HIV-positive participants from three randomized controlled trials that had recruited participants from routine HIV testing programs. HIV-negative controls were recruited from the community. Data were collected on demographics, cardiovascular risk factors, medical history and electrocardiographic and echocardiographic characteristics. Results In total, 394 HIV-positive participants and 153 controls were enrolled. The mean age of HIV-positive participants was 40±9 years (controls: 35±10 years), and 34% were male (controls: 50%). Of HIV-positive participants 36% were overweight or obese (controls: 44%), 23% had hypertension (controls: 28%) and 12% were current smoker (controls: 37%). Median time since HIV diagnosis was 6.0 years (IQR 2.3–10.0) and median treatment duration was 4.0 years (IQR 0.0–8.0), 50% had undetectable viral load. The frequency of anatomical cardiac abnormalities was low and did not differ between people with and without HIV. We observed no relation between HIV or anti-retroviral therapy (ART) and systolic or diastolic heart function. There was an association between ART use and corrected QT interval: +11.8 ms compared to HIV-negative controls (p<0.01) and +18.9 ms compared to ART-naïve participants (p = 0.01). We also observed a higher left ventricular mass index in participants on ART (+7.8 g/m2, p<0.01), but this association disappeared after adjusting for CD4 cell count, viral load and HIV-duration. Conclusion The low number of major cardiac abnormalities in this relatively young, well managed urban African HIV-positive population is reassuring. The increase in corrected QT interval and left ventricular mass may contribute to higher cardiac mortality and morbidity in people living with HIV in the long term.

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Physical activity and exercise for older people living with HIV: a protocol for a scoping review

Systematic Reviews ◽

10.1186/s13643-020-01327-4 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Levin Chetty ◽

Saul Cobbing ◽

Verusia Chetty

Keyword(s):

Physical Activity ◽

Older People ◽

Scoping Review ◽

People Living With Hiv ◽

Physical Activity And Exercise ◽

Living With Hiv

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CTN 328: immunogenicity outcomes in people living with HIV in Canada following vaccination for COVID-19 (HIV-COV): protocol for an observational cohort study

BMJ Open ◽

10.1136/bmjopen-2021-054208 ◽

2021 ◽

Vol 11 (12) ◽

pp. e054208

Author(s):

Cecilia T Costiniuk ◽

Joel Singer ◽

Marc-André Langlois ◽

Iva Kulic ◽

Judy Needham ◽

...

Keyword(s):

Cohort Study ◽

Immune Responses ◽

Guideline Development ◽

Vaccine Dose ◽

People Living With Hiv ◽

Similar Time ◽

Dosing Strategies ◽

Living With Hiv ◽

Negative Controls ◽

Hiv Negative

IntroductionMost existing vaccines require higher or additional doses or adjuvants to provide similar protection for people living with HIV (PLWH) compared with HIV-uninfected individuals. Additional research is necessary to inform COVID-19 vaccine use in PLWH.Methods and analysisThis multicentred observational Canadian cohort study will enrol 400 PLWH aged >16 years from Montreal, Ottawa, Toronto and Vancouver. Subpopulations of PLWH of interest will include individuals: (1) >55 years of age; (2) with CD4 counts <350 cells/mm3; (3) with multimorbidity (>2 comorbidities) and (4) ‘stable’ or ‘reference’ PLWH (CD4 T cells >350 cells/mm3, suppressed viral load for >6 months and <1 comorbidity). Data for 1000 HIV-negative controls will be obtained via a parallel cohort study (Stop the Spread Ottawa), using similar time points and methods. Participants receiving >1 COVID-19 vaccine will attend five visits: prevaccination; 1 month following the first vaccine dose; and at 3, 6 and 12 months following the second vaccine dose. The primary end point will be the percentage of PLWH with COVID-19-specific antibodies at 6 months following the second vaccine dose. Humoral and cell-mediated immune responses, and the interplay between T cell phenotypes and inflammatory markers, will be described. Regression techniques will be used to compare COVID-19-specific immune responses to determine whether there are differences between the ‘unstable’ PLWH group (CD4 <350 cells/mm3), the stable PLWH cohort and the HIV-negative controls, adjusting for factors believed to be associated with immune response. Unadjusted analyses will reveal whether there are differences in driving factors associated with group membership.Ethics and disseminationResearch ethics boards at all participating institutions have granted ethics approval for this study. Written informed consent will be obtained from all study participants prior to enrolment. The findings will inform the design of future COVID-19 clinical trials, dosing strategies aimed to improve immune responses and guideline development for PLWH.Trial registration numberNCT04894448.

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