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Cognitive function and depression in HIV-positive individuals and matched controls
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Reported by Jules Levin
HIV Glasgow 2016 Oct 23-26
Davide De Francesco1, Jonathan Underwood2, Marta Boffito3, Frank Post4, Patrick W.G. Mallon5, Jaime H. Vera6, Ian Williams1, Jane Anderson7, Margaret Johnson8, Caroline A. Sabin1and Alan Winston2on behalf of the POPPY study group
1Department of Infection & Population Health, UCL, London, UK 2Division of Infectious Diseases, Imperial College London, UK
3Chelsea and Westminster Hospital, London, UK 4Kings College Hospital, London, UK 5UCD School Of Medicine, Dublin, Ireland
6Brighton and Sussex Medical School, Brighton, UK 7Homerton University Hospital, London, UK 8Royal Free Hospital, London, UK
Program abstract:
from Jules: ITS NOT just depression that mediates poor cognitive function, the affect of HIV on the brain never goes away - HIV enters the brain right after infection & remains there, the affects renin & may not be easily identified by patient survey and after 30-40 years of infection as patients age HIV+ suffer worse neurologic decline. A history of substance abuse worsens decline, current comorbidities & frailty can worsen the decline.
Introduction: Cognitive disorders and depression remain prevalent in people living with HIV (PLWH) [1,2]; however, few studies have investigated the interaction between these comorbidities. We describe overall cognitive function in a large cohort of PLWH compared
to an appropriate control population and explore factors associated with cognitive performance, including depression and lifestyle factors.
Methods: One thousand two hundred and sixty-six individuals (643 PLWH aged >50 years, 343 PLWH <50 years and 280 HIV-negative
controls >50 years) were enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty study and completed a computerised assessment (CogState) of cognitive function covering six domains. Raw test scores were standardized into Z-scores (mean 0, SD 1) and averaged to obtain domain and global Z-scores. Depression was evaluated via the Patient Health Questionnaire (PHQ-9) and classified as none (score 04), mild (59), moderate (1014) or severe (1527). Differences between the three groups and the effect of depression, socio-demographic and lifestyle factors on cognitive performance were evaluated using median regression. All analyses accounted for age, gender, ethnicity and level of education.
Results:PLWH aged >50 and <50 years and HIV-negative controls aged >50 were predominantly male (88%, 81% and 65%, respectively), of white ethnicity (87%, 81% and 90%, respectively), with a median age (IQR) of 56 (5362), 43 (3747) and 58 (5363) years, respectively. Current alcohol consumption and recreational drugs use were reported in 80%, 81% and 87% (p0.009) and 26%, 34% and 15% (p=0.001), respectively, of PLWH aged>]50 and <50 years and HIVnegative controls. After adjusting for socio-demographics, PLWH aged >50 and <50 years had reduced global cognitive scores than HIVnegative controls [adjusted difference between medians (95% CI) was 0.090 (0.149, 0.032), p0.003, and 0.080 (0.166, 0.007), p0.07, respectively]. Moderate or severe depression was more prevalent in PLWH aged >50 (27%, p<0.001) and <50 years (22%, p<0.001) compared to HIV-negative controls (8%). Depression (p<0.001), years of drinking (p=0.003), smoking status (p=0.01) and use of marijuana (=0.02) were associated with cognitive function in univariate analyses, but only depression (p<0.001) and years of drinking (p=0.008) remained significantly associated in multivariable analyses. After further adjusting for depression and years of drinking, differences between groups were not statistically significant (Figure 1). Unadjusted (dotted line), adjusted for age, gender, ethnicity and level of education only (dashed line) and adjusted for age, gender, ethnicity, level of education, depression and years of drinking.
Conclusion: Reduced cognitive performance in HIV infected individuals appears to be partially mediated by depressive disorders. However, this may also indicate that depression and cognitive impairment in PLWH share a common aetiology and could be related to similar underlying inflammatory processes.
References
1. Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL,
LeBlanc S, et al. HIV-associated neurocognitive disorders before and
during the era of combination antiretroviral therapy: differences in
rates, nature, and predictors. J Neurovirol. 2011;17:316. doi: http://
dx.doi.org/10.1007/s13365-010-0006-1
2. Magidson JF, Skeer MR, Mayer KH, Safren SA. Prevalence of
psychiatric and substance abuse symptomatology among HIVinfected
gay and bisexual men in HIV primary care. Psychosomatics.
2015;56:4708. doi: http://dx.doi.org/10.1016/j.psym.2014.08.004
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