Characterization of HIV-Associated Neurocognitive Impairment in Middle-Aged and Older Persons With HIV in Lima, Peru

Abstract

Background: With widespread use of antiretroviral medications, people living with HIV (PWH) are living longer worldwide, increasing their risk of developing neurocognitive impairment (NCI). The proportion of Peruvians over age 60 is expected to increase to 25% of the population by 2050, including PWH. Therefore, the problem of aging and NCI, especially in the setting of HIV infection, is uniquely pressing. We sought to study the rates of and risk factors associated with NCI among middle-aged and older PWH in Lima, Peru.Materials and Methods: Sociodemographic, medical (infectious and non-infectious), and psychiatric comorbidity and laboratory data were collected. We administered a brief neuropsychological battery evaluating seven cognitive domains affected in HIV-associated NCI and a depression screening. Cognitive test raw scores were converted to T-scores that were demographically adjusted. Descriptive statistics were performed together with regression (unadjusted and adjusted) analyses to determine potential risk factors for NCI among PWH.Results: This was a cross-sectional study in which 144 PWH aged ≥40 years attending a large HIV clinic in Lima, Peru, were recruited from September 2019 to March 2020. Mean age was 51.6 ± 7.7 years, and mean years of education were 14.0 ± 3.1 with 15% females. Median [interquartile range (IQR)] current CD4 and nadir CD4 were 554 (371, 723) and 179 (83, 291), respectively, and 10% currently had AIDS. The prevalence of NCI was 28.5%, and many demonstrated difficulty with attention and working memory (70%). One-quarter of PWH had mild depression or worse on Patient Health Questionnaire 9 (PHQ-9 ≥ 5). In bivariate analyses, neither a depression history nor a higher PHQ-9 score correlated with NCI. No other non-communicable medical or psychiatric comorbidity nor HIV characteristic was predictive of NCI. Having a positive lifetime history of hepatitis B infection, pulmonary tuberculosis, or syphilis increased risk of NCI (PR 1.72; 95% CI 1.04–2.86) in unadjusted analyses, but not in adjusted analyses.Conclusions: NCI among older Peruvians with HIV was found to be highly prevalent with levels consistent with prior reports of HIV-associated NCI worldwide. Common latent HIV-associated co-infections, including latent syphilis, hepatitis B infection, or pulmonary tuberculosis, may increase the risk of NCI among middle-aged and older PWH in Peru.

Sociodemographic Characteristics of HIV-Associated Dementia in the South Carolina Alzheimer’s Disease Registry

“…The highest odds in the present study were seen comparing populations aged 35 to 44 years to those 85 and older for both time periods. Previous research has shown that HIV is the most prevalent cause of dementia among younger adults 3,24,25 ; however, research tends to focus on middle-aged and older adults with respect to HAD assessments 26,27 . Nevertheless, the present study shows that HAD is of crucial concern among younger populations.…”

“…Previous research has shown that HIV is the most prevalent cause of dementia among younger adults 3,24,25 ; however, research tends to focus on middle-aged and older adults with respect to HAD assessments. 26,27 Nevertheless, the present study shows that HAD is of crucial concern among younger populations. Although there are HIV intervention and prevention programs geared toward youth [28][29][30] and there has been increasing attention paid to older adults, 31,32 middle-aged adults are sometimes forgotten with respect to HIV prevention and intervention programs.…”

Sirtuins Modulation: A Promising Strategy for HIV-Associated Neurocognitive Impairments

“…Finally, people diagnosed with HAD have a performance of 2 SD below the mean in two cognitive domains and evident difficulty in the achievement of day-to-day activities [ 3 , 6 ]. HAND causes a spectrum of cognitive impairment, motor dysfunction, and behavioral and emotional disorders [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”