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Long Term Cognitive Decline in People Living With HIV

Change was associated with risk factors that have not been reported like chronic lung disease.

The brain is one of the main targets of the human immunodeficiency virus (HIV). Shortly after infection, the virus crosses the blood-brain barrier and gets into the central nervous system where it has a significant impact on the brain and certain nerves. This can lead to a wide range of neurological symptoms.

There have been many studies that have assessed cognitive decline in people with HIV (PWH) over the span of a few years. However, there have never been any that have looked at cognitive change over the course of a decade or more.

Recently, investigators have assessed the cognitive decline in PWH over a 12 year period. The data was presented during the Conference on Retroviruses and Opportunistic Infections (CROI) 2021 virtual sessions.

The study included 397 participants who were part of the 6-site, U.S. CHARTER project and were assessed for cognitive change at an initial visit and at a follow up visit 12 years later. The change was assessed via a neuropsychological test battery that assessed 7 cognitive domains as well as medical history, prescribed medications, drug use, and blood collection.

The outcome was calculated using a regression-based change score (RBCS) with normative data from people without HIV. Decline was defined as change worse than the 5th percentile of the normative data.

The mean age at the 12-year visit was 56, with 23% being women, 58% having race or ethnicity other than white, and 96% having taken antiretroviral therapy (ART) for a mean of 15.3 years.

Findings from the study showed that 23.4% of the participants met the criterion for cognitive decline. The best model showed worse RBCS was associated with chronic lung disease. The model also showed people with diabetes and major depressive disorder (MDD) had worse cognitive decline than people with diabetes without MDD or people with neither condition.

Additionally, hypertension combined with diabetes and chronic lung disease was incrementally associated with a cognitive decline. Overall, a quarter of PWH experienced cognitive decline over the 12 years study period and those with aging-related risk factors had a worse change than those without.