Cognitive Concerns are a Risk Factor for Mortality in People with Human Immunodeficiency Virus and COVID-19 (S21.003)

Abstract

<h3>Objective:</h3> To assess the contribution of cognitive symptoms to risk of mortality from COVID-19 in people with HIV (PWH). <h3>Background:</h3> Despite higher prevalence of cognitive disorders in PWH and dementia being a risk factor for COVID-19 mortality, the association between cognitive impairment and adverse outcomes in PWH with COVID-19 has not been well established. <h3>Design/Methods:</h3> Matched case-control study (1:10) of PWH and without (PWoH) with documented SARS-CoV-2 PCR positivity from March 2020-March 2021 evaluated at a Boston-based healthcare system. Data were extracted from the electronic health record. Matching was on age, sex, race, and zip code. Primary exposures were dementia (ICD-10 code) and cognitive concerns (concern for impairment within 12 months pre-COVID-19, ascertained using a semi-automated chart annotation tool). VACS2.0 Index (including general and HIV-specific biomarkers) was calculated. VACS2.0 Index-adjusted logistic regression models assessed effect of dementia and cognitive concerns on odds of death (OR[95% confidence interval]). <h3>Results:</h3> Among 14,129 patients with COVID-19, 64 PWH were identified and matched to 463 PWoH. Among PWH, 89% were on antiretroviral therapy, 87% had an HIV-1 viral load &lt;200 copies/mL, and 19% had CD4 &lt;200 cells/μL. VACS2.0 score predicted level of care and mortality in both PWH and PWoH. PWH had higher prevalence of dementia (16% vs. 6%, p=0.01) and cognitive concerns (22% vs. 16%, p=0.04). Death was more frequent in PWH (17% vs. 6%, p&lt;0.01), at younger ages (58 vs. 66 years, p=0.03). VACS2.0-adjusted regression models found cognitive concerns (2.4[1.1–5.3], p=0.03) and dementia (2.4[1.0–5.8], p=0.05) significantly associated with odds of death in the overall group. Among PWH only, aOR for cognitive concern approached significance (3.9[0.81–20.19], p=0.09), while dementia (1.75[0.29–8.71], p=0.50) did not. <h3>Conclusions:</h3> Dementia and cognitive concerns were associated with mortality among people with COVID-19, and the magnitude of the effect of cognitive impairment may be greater in PWH. Assessment of cognitive status is an important component to care for PWH in the COVID-19 era. <b>Disclosure:</b> Ms. Rudmann has nothing to disclose. Dr. Wilcox has nothing to disclose. Elissa Ye has received personal compensation for serving as an employee of Massachusetts General Hospital. Mr. Noori has nothing to disclose. Colin Magdamo has received research support from National Institutes of Health. Aayushee Jain has nothing to disclose. Dr. Alabsi has received personal compensation for serving as an employee of Biogen. Virginia Triant has nothing to disclose. The institution of Gregory Robbins has received research support from Gilead Sciences. The institution of Gregory Robbins has received research support from Citius Pharm. The institution of Gregory Robbins has received research support from Emergent Biosolutions. The institution of Gregory Robbins has received research support from Pfizer. The institution of Gregory Robbins has received research support from Leonard Meron Biosciences. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities. An immediate family member of Sudeshna Das has received personal compensation for serving as an employee of Alix Partners. An immediate family member of Sudeshna Das has received stock or an ownership interest from Alix Partners. The institution of Sudeshna Das has received research support from NIA. The institution of Sudeshna Das has received research support from Mass Life Sciences Center. The institution of Sudeshna Das has received research support from IOS Press. Dr. Mukerji has stock in Gilead Science. The institution of Dr. Mukerji has received research support from NIH. The institution of Dr. Mukerji has received research support from Massachusetts General Hospital.