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.
Highlights
The number of people living with dementia of any cause worldwide in 2015 was estimated at 48 million people, and this figure is expected to rise to 135 million by 2050, with 63% of cases living in low- and middle-income countries (LMICs) [1]
We found that nearly 30% of participants had global neurocognitive impairment (NCI) and that all participants with global NCI had asymptomatic NCI with no participants having mild neurocognitive disorder or HIV-associated dementia
In a sub-analysis of people living with HIV (PWH) with an undetectable plasma viral load only (n = 126), we found that 28.6% of PWH had NCI, and in the unadjusted regression analyses, the PR of HIV positivity on NCI remained unchanged
Summary
The number of people living with dementia of any cause worldwide in 2015 was estimated at 48 million people, and this figure is expected to rise to 135 million by 2050, with 63% of cases living in low- and middle-income countries (LMICs) [1]. With increased access and use of antiretroviral therapy (ART), the life expectancy of people living with HIV (PWH) has markedly increased [2, 3]. This represents a breakthrough in the field and a new challenge due to the increasing prevalence of non-communicable comorbidities, such as diabetes mellitus and hyperlipidemia, associated with aging with HIV including various forms of neurocognitive impairment (NCI) [4, 5]. With widespread use of antiretroviral medications, people living with HIV (PWH) are living longer worldwide, increasing their risk of developing neurocognitive impairment (NCI). We sought to study the rates of and risk factors associated with NCI among middle-aged and older PWH in Lima, Peru
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