The persistent disparity in brain health among aging people with HIV

Gutierrez, José

doi:10.1097/qad.0000000000003148

Aids

2022

DOI: 10.1097/qad.0000000000003148

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The persistent disparity in brain health among aging people with HIV

José Gutierrez

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2024

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Cited by 2 publications

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Undiagnosed Cognitive Impairment and Impact on Instrumental Activities of Daily Living Among People With HIV Infection in Primary Care

Lam

Hou

Gilsanz

et al. 2023

Open Forum Infectious Diseases

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Background Little is known about the prevalence of undiagnosed cognitive impairment and its impact on instrumental activities of daily living (IADL) among people with HIV (PWH) in primary care Setting U.S. integrated healthcare system Methods PWH were recruited from an integrated healthcare setting. PWH were eligible for recruitment if they were ≥50 years old, taking antiretroviral therapy (i.e., ≥1 ART prescription fill in the past year), and had no clinical diagnosis of dementia. Participants completed a cognitive screen (St. Louis University Mental Status exam) and a questionnaire on IADL (modified Lawton-Brody). Results Study participants (N=47) were mostly male (85.1%), 51.1% White, 25.5% Black, 17.0% Hispanic, and the average age was 59.7 years (standard deviation, SD=7.0 years). Overall, 27 (57.5%) participants were categorized as cognitively normal, 17 (36.2%) as having mild cognitive impairment, and 3 (6.4%) as having possible dementia. Of the 20 participants with mild cognitive impairment or possible dementia, 85.0% were men, the average age was 60.4 years (SD=7.1 years); 45.0% were White, 40.0% were Black, 10.0% were Hispanic, and 30.0% reported difficulty with at least one IADL. Most (66.7%) attributed difficulty with IADL primarily (33.3%) or in part (33.3%) to cognitive problems. Conclusion Undiagnosed cognitive impairment is frequent among ART-treated PWH, with possible elevated risk among Black PWH, and may be accompanied by difficulty with IADL. Efforts are needed to optimize identification of factors contributing to cognitive and IADL difficulties among ART-treated PWH in primary care.

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Undiagnosed Cognitive Impairment and Impact on Instrumental Activities of Daily Living Among People With HIV Infection in Primary Care

Lam

Hou

Gilsanz

et al. 2023

Open Forum Infectious Diseases

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Hypertension control and risk of age-associated dementia in people with HIV infection

Lam,

Hou,

Lee

et al. 2024

Aids

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Objective: Hypertension is a major risk factor for dementia, but sustained blood pressure control is difficult to achieve. We evaluated whether inadequately controlled hypertension may contribute to excess dementia risk among people with HIV. Design: Retrospective cohort study. Methods: We studied demographically matched people with and without HIV between 7/1/2013 and 12/31/2021 who were ≥50 years old and had a hypertension diagnosis but no dementia diagnosis. Hypertension control was calculated using a disease management index (DMI) which captured degree and duration above the hypertension treatment goals of systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg. DMI values ranged from 0% to 100% (perfect control); hypertension was considered “inadequately controlled” if DMI<80% (i.e., in control for <80% of the time). Annual, time-updated DMI was calculated for SBP and DBP. Associations of SPB and DPB control with incident dementia were evaluated using extended Cox regression models. Results: The study included 3,099 hypertensive people with HIV (mean age: 58.3 years, 90.2% men) and 66,016 people without HIV. Each year of inadequate SBP control was associated with greater dementia risk in both people with HIV (adjusted hazard ratio [aHR] = 1.26, 0.92–1.64) and people without HIV (aHR = 1.27 (1.21–1.33); p-interaction = 0.85). Similarly, inadequate DBP control was associated with greater dementia risk in both people with HIV (aHR = 1.43, 0.90–1.95) and people without HIV (aHR = 1.71, 1.50–1.93; p-interaction = 0.57). Conclusions: Findings suggest the association of inadequate hypertension control with greater dementia risk is similar by HIV status. Stronger associations of DBP control with dementia merits further investigation.

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The persistent disparity in brain health among aging people with HIV

Cited by 2 publications

References 31 publications

Undiagnosed Cognitive Impairment and Impact on Instrumental Activities of Daily Living Among People With HIV Infection in Primary Care

Undiagnosed Cognitive Impairment and Impact on Instrumental Activities of Daily Living Among People With HIV Infection in Primary Care

Hypertension control and risk of age-associated dementia in people with HIV infection

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