Neurocognitive course at 2-year follow-up in a Swiss cohort of people with well-treated HIV

Abstract

Objective: The aim of this study was to examine neurocognitive course over time among people with well treated HIV. Design: The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is an ongoing, prospective, longitudinal, multicenter and multilingual study within the Swiss HIV Cohort Study (SHCS). Participants undergo neuropsychological assessment at baseline and two-yearly follow-up. Setting: Seven SHCS centres. Participants: Patients aged at least 45 years enrolled in the SHCS with fluency in the local language (French, German or Italian) and agreeing to participate in the NAMACO study: 981 participants at baseline, 720 at 2-year follow-up of whom 644 had complete data sets. Intervention: Standardized neuropsychological assessment at baseline and 2-year follow-up. Main outcome measure: Neurocognitive performance using Frascati criteria and mean z -scores. Results: Four participants (of 644, 0.6%) had plasma HIV-1 RNA more than 50 copies/ml; median CD4 + cell count was 660 cells/μl. According to Frascati criteria, 204 participants (31.7%) had neurocognitive impairment (NCI) at baseline. NCI severity in these participants changed little over 2 years and comprehensive models based on Frascati criteria were not feasible. Examining mean z -scores, however, we observed neurocognitive stability or improvement over two years in five of seven neurocognitive domains assessed. Age at least 65 years ( P = 0.02) and cognitive complaints ( P = 0.004) were associated with neurocognitive decline, while black race ( P = 0.01) and dolutegravir treatment ( P = 0.002) were associated with improvement. Conclusion: Frascati criteria were less sensitive in measuring NCI change and therefore unsuitable for following neurocognitive course in our cohort of people with well treated HIV. Examining neurocognitive course by mean z-score change, we observed stability or improvement.

Anticholinergic and Sedative Medications Are Associated With Neurocognitive Performance of Well Treated People With Human Immunodeficiency Virus

“…The NAMACO study was established to evaluate the impact of HIV infection on the neurocognitive function in an aging HIV-infected population. Study methods have been previously described [ 23 , 24 ]. In brief, SHCS participants were eligible for NAMACO inclusion if they had a diagnosis of HIV, were aged ≥45 years, and had sufficient oral fluency to undergo a thorough NP evaluation.…”

“…The evaluated domains included motor skills, speed of information processing, attention and working memory, executive functions, and verbal episodic memory. Specific tests to evaluate each domain have been described previously [ 23 , 24 ]. Raw scores for each NP test were converted to demographically adjusted standard scores (or z-scores).…”

One for all, all for one: neuro‐HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV

“…Among PLWH referred to the neuro‐HIV platform for neurological and cognitive complaints, 75% had NCI, with NHNCI representing 73.4% of the whole NCI group (55.1% of all platform participants had NHNCI). This NHNCI prevalence is around four times higher than that among participants of the NAMACO study, where NHNCI prevalence was 13% at baseline and 10% at 2‐year follow‐up [4, 8]. We also found NHNCI to be particularly prevalent among female participants, who were mainly of African origin, where NHNCI was more prevalent than among male participants of the same origin.…”

“…Among participants of the Neurocognitive Assessment in the Metabolic and Ageing Cohort (NAMACO) study in Switzerland, between 27% and 40% of PLWH have been diagnosed with NCI [4,8], based on the Frascati criteria, the 2007 consensus criteria for the diagnosis of NCI among PLWH, which classify HIV-NCI as asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), HIV-associated dementia (HAD), and non-HIVassociated neurocognitive impairment (NHNCI) [9]. Even if most NCI diagnoses are mild forms, the differential diagnosis and treatment of cognitive deficits is complex, in particular when different aspects (social, medical, pharmaceutical, stigma and psychological) of being a PLWH collide.…”

Declining Prevalence of Human Immunodeficiency Virus (HIV)–Associated Neurocognitive Disorders in Recent Years and Associated Factors in a Large Cohort of Antiretroviral Therapy–Treated Individuals With HIV

“…In particular, INSTIs are highly effective in both plasma and the CNS, resulting in suppression of HIV replication and, potentially, in better NCP. Moreover, when neuropsychiatric symptoms are reported with the use of INSTIs in several post-marketing studies, their effects, beneficial or detrimental, on NCP are not well clarified [ 12 , 40–42 ]. In our analysis, INSTI-based regimens, prescribed in 20% of the study population (15% as triple and 5% as dual therapy), seemed to have a protective role in neurocognition in terms of reduced risk of HAND.…”