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Neuro Impairment in Over One Third of
London HIV Group--Anxiety Doubles Risk
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HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow
Mark Mascolini
More than one third of a large London group with HIV infection had neurocognitive impairment (NCI) in a cross-sectional study [1]. Anxiety, low education, black race, and higher (better) antiretroviral CNS penetration effectiveness (CPE) score independently predicted NCI in this 710-person analysis.
Several studies show that HIV-associated neurocognitive disorder persists in HIV populations, though most cases are mild and asymptomatic. Researchers at Barts Health NHS Trust conducted this study to determine NCI prevalence in a large unselected HIV cohort and to identify predictors of NCI.
The investigators recruited 786 HIV-positive adults from 4 HIV clinics in East and South London. They used medical records to collect demographic and clinical data, and participants completed computerized assessment of neurocognitive function with 5 Cogstate tests: psychomotor function, attention, executive function, visual learning, and working memory. The researchers defined NCI as a score more than 1 standard deviation outside the population average in 2 or more of these domains. They assessed anxiety with the Hospital Anxiety and Depression scale.
The study group had a median age of 46 (interquartile range [IQR] 39 to 52) and a median CD4 count of 566 (IQR 412 to 741). Two thirds of participants were white, 81% had a viral load below 100 copies, and 26% currently smoked. Among 710 participants who completed the Cogstate tests, 264 (37.2%) met NCI criteria. Proportions of participants impaired in each domain were 28.0% for attention, 27.7% for psychomotor function, 25.2% for visual learning, 24.9% for working memory, and 19.2% for executive function.
Multivariate analysis identified 5 factors linked to higher odds of NCI and 1 factor that predicted lower odds, at the following adjusted odds ratios (aOR):
Higher odds of NCI
-- Test-determined anxiety: aOR 2.47, P = 0.0001
-- Abnormal on International HIV Dementia Scale: aOR 3.90, P = 0.0001
-- Less than college education: aOR 1.73, P = 0.004
-- HIV transmission other than gay sex: aOR 1.96, P = 0.003
-- Antiretroviral CPE score above 8: aOR 3.22, P = 0.037
Lower odds of NCI
-- Caucasian versus black: aOR 0.22, P = 0.0001
The association between higher (better) antiretroviral CPE score and greater odds of NCI adds to conflicting findings with this tool [2]. The London investigators suggested the link higher CPE score and worse cognitive function could reflect antiretroviral toxicity or antiretroviral intensification in people with early signs of NCI.
References
1. Rackstraw S, Davies O, Thiyagarajan A, et al. Factors associated with HIV-associated neurocognitive disorder in an unselected cohort in East and South London: the HAND study. HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow. Abstract P200.
2. Berger JR, Clifford DB. The relationship of CPE to HIV dementia: slain by an ugly fact? Neurology. 2014;83:109-110. http://n.neurology.org/content/83/2/109.long
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