Alcohol consumption and neurocognitive deficits in people with well-treated HIV in Switzerland.

Katharine E A Darling ,Renaud Du Pasquier,Peter Brugger,Matthias Cavassini,Caroline Di Benedetto,Klemens Gutbrod,Philip E Tarr,Stefania Rossi,Barbara Hasse,Marcel Stoeckle,Nadia Benghalem,Severin Früh,Isaure Nadin,Isabella Locatelli,Alexandra Calmy,Christoph Hauser,Helen Kovari,Patrick Schmid,C A Fux ,Jean‐Bernard Daeppen ,Ursula Kunze

doi:10.1371/journal.pone.0246579

Abstract

BackgroundHazardous alcohol consumption and HIV infection increase the risk of neurocognitive impairment (NCI). We examined the association between alcohol consumption and specific neurocognitive domain function in people with HIV (PWH) taking modern antiretroviral therapy.MethodsThe Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is a prospective, longitudinal, multicentre and multilingual (French, German and Italian) study of patients aged ≥45 years old enrolled in the Swiss HIV Cohort Study (SHCS). Baseline data from 981 study participants were examined. Five neurocognitive domains were evaluated: motor skills, speed of information processing, attention/working memory, executive function and verbal episodic memory. NCI was examined as binary (presence/absence) and continuous (mean z-score) outcomes against Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) scores using logistic and linear regression models, respectively.ResultsMost participants (96.2%) had undetectable viral loads and 64% were aged >50 years old. Hazardous alcohol consumption was observed in 49.4% of participants and binge drinking in 4.2%. While alcohol consumption frequency and quantity were not associated with NCI, the practice of binge drinking was significantly associated with impaired motor skills and overall neurocognitive function in both binary (odds ratio, OR ≥2.0, P <0.05) and continuous (mean z-score difference -0.2 to -0.4, P ≤0.01) outcomes. A significant U-shaped distribution of AUDIT-C score was also observed for motor skills and overall neurocognitive function.ConclusionsIn this cohort of PWH with well-controlled HIV infection, NCI was associated with the practice of binge drinking rather than alcohol consumption frequency or quantity. Longitudinal analysis of alcohol consumption and NCI in this population is currently underway.

Highlights

HIV-associated neurocognitive impairment (NCI) represents a clinical challenge which will grow as people with HIV (PWH) continue to age
Hazardous alcohol consumption was observed in 49.4% of participants and binge drinking in 4.2%
While alcohol consumption frequency and quantity were not associated with NCI, the practice of binge drinking was significantly associated with impaired motor skills and overall neurocognitive function in both binary and continuous outcomes

Summary

Introduction

HIV-associated neurocognitive impairment (NCI) represents a clinical challenge which will grow as people with HIV (PWH) continue to age. In the era of modern and highly efficacious antiretroviral therapy (ART), potentially modifiable factors affecting HIV course such as alcohol consumption merit review. The combination of hazardous alcohol consumption and HIV appears to have an association with NCI beyond that of alcoholism or HIV as single diagnoses [1]. Hazardous alcohol consumption has been observed to be associated with impaired health-related quality of life, impaired ART adherence and ART interruption, all of which potentially affect neurocognitive function [4,5,6,7]. In PWH of increasing age, previous hazardous consumption appears to maintain an association with NCI [8,9,10,11]. We examined the association between alcohol consumption and specific neurocognitive domain function in people with HIV (PWH) taking modern antiretroviral therapy

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Results

Conclusion