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

Abstract

Objectives We investigated whether differences in cognitive performance between people living with HIV ( PLWH ) and comparable HIV ‐negative people were mediated or moderated by depressive symptoms and lifestyle factors. Methods A cross‐sectional study of 637 ‘older’ PLWH aged ≥ 50 years, 340 ‘younger’ PLWH aged < 50 years and 276 demographically matched HIV ‐negative controls aged ≥ 50 years enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty ( POPPY ) study was performed. Cognitive function was assessed using a computerized battery (CogState). Scores were standardized into Z ‐scores [mean = 0; standard deviation ( SD ) = 1] and averaged to obtain a global Z ‐score. Depressive symptoms were evaluated via the Patient Health Questionnaire ( PHQ ‐9). Differences between the three groups and the effects of depression, sociodemographic factors and lifestyle factors on cognitive performance were evaluated using median regression. All analyses accounted for age, gender, ethnicity and level of education. Results After adjustment for sociodemographic factors, older and younger PLWH had poorer overall cognitive scores than older HIV ‐negative controls ( P < 0.001 and P = 0.006, respectively). Moderate or severe depressive symptoms were more prevalent in both older (27%; P < 0.001) and younger (21%; P < 0.001) PLWH compared with controls (8%). Depressive symptoms ( P < 0.001) and use of hashish ( P = 0.01) were associated with lower cognitive function; alcohol consumption ( P = 0.02) was associated with better cognitive scores. After further adjustment for these factors, the difference between older PLWH and HIV ‐negative controls was no longer significant ( P = 0.08), while that between younger PLWH and older HIV ‐negative controls remained significant ( P = 0.01). Conclusions Poorer cognitive performances in PLWH compared with HIV ‐negative individuals were, in part, mediated by the greater prevalence of depressive symptoms and recreational drug use reported by PLWH .

Risky Alcohol Consumption and Associated Health Behaviour Among HIV-Positive and HIV-Negative Patients in a UK Sexual Health and HIV Clinic: A Cross-Sectional Questionnaire Study

“…Eleven percent of HIV-positive patients reported moderate or severe depressive symptoms when measured using the PHQ-9 questionnaire. Previous studies utilising the PHQ-9 questionnaire have reported higher prevalences of depression among HIV-positive patients compared to our study, ranging from 14.5 to 27% [29][30][31]. Sociodemographic characteristics of our patients may in part explain the disparities in findings.…”

Assessment and Management of HIV-Associated Cognitive Impairment: Experience from a Multidisciplinary Memory Service for People Living with HIV

“…The clinical relevance of seeking to ‘diagnose’ ‘asymptomatic’ CI has been called into question as wasteful of resources and needlessly worrying to patients. Recent findings have shown that ANI is predictive of further cognitive decline [42] but the main moderators of these changes are common to all, including older age, cardiovascular risk factors (diabetes, hypertension, smoking), presence of depression and other health comorbidities [42,43,44]. Medication treatment strategies for CI have generally proved disappointing, within the clinic we modified cART regimens only due to patient complaint of side effects (and would have modified if presence of CSF HIV RNA was detected); besides this little recommendation or indeed clarity of evidence exists.…”

“…Interventions addressing cardiovascular risk factors and mental wellbeing appear to be of value [42,44]. At the clinic we offer patients informal advice on lifestyle (e.g., diet, exercise, sleep hygiene, drugs/alcohol intake), mental health management, adherence to cART and cognitive strategies, along with recommendations to their GP on the control of CVD risk factors.…”

Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study

“…We calculated z -scores for individual TOVA variables and Cogstate subtests using the HIV-negative cohort as the reference sample. We then calculated global scores of executive function, speed of processing, and central auditory scores from the z -scores using an approach similar to those proposed by Kamminga et al [ 48 ] and De Francesco et al [ 52 ]. These global scores allowed us to better understand the key domains of cognition, executive function, and speed of processing.…”