Abstract
Despite the neurocognitive risks of aging with HIV, initial cross-sectional data suggest a subpopulation of older people with HIV (PWH) possess youthful neurocognition (NC) characteristic of SuperAgers (SA). Here we characterize longitudinal NC trajectories of older PWH and their convergent validity with baseline SA status, per established SuperAging criteria in PWH, and baseline biopsychosocial factors. Growth mixture modeling (GMM) identified longitudinal NC classes in 184 older (age ≥ 50-years) PWH with 1–5 years of follow-up. Classes were defined using ‘peak-age’ global T-scores, which compare performance to a normative sample of 25-year-olds. 3-classes were identified: Class 1Stable Elite (n = 31 [16.8%], high baseline peak-age T-scores with flat trajectory); Class 2Quadratic Average (n = 100 [54.3%], intermediate baseline peak-age T-scores with u-shaped trajectory); Class 3Quadratic Low (n = 53 [28.8%], low baseline peak-age T-scores with u-shaped trajectory). Baseline predictors of Class 1Stable Elite included SA status, younger age, higher cognitive and physiologic reserve, and fewer subjective cognitive difficulties. This GMM analysis supports the construct validity of SuperAging in older PWH through identification of a subgroup with longitudinally-stable, youthful neurocognition and robust biopsychosocial health.
Highlights
In the U.S and other developed countries, HIV is no longer considered a rapidly debilitating terminal illness, but rather a chronic medical condition when treated with modern antiretroviral therapy (ART) [1]
Differentiating patterns of neurocognition within unimpaired individuals, such as separating out typical neurocognitive aging from superior neurocognitive aging, can enhance understanding of the factors that promote sustained neurocognition compared to factors that ward off neurocognitive impairment (NCI) but do not prevent “normal” age-related decline
Participants included 184 older persons with HIV (PWH) enrolled in the central nervous system (CNS) HIV Antiretroviral Therapy Effects Research (CHARTER) study [24] from 2003 to 2017
Summary
In the U.S and other developed countries, HIV is no longer considered a rapidly debilitating terminal illness, but rather a chronic medical condition when treated with modern antiretroviral therapy (ART) [1]. Despite the neurocognitive hazards of aging with HIV, prior work has identified a subgroup of older (≥ 50-years) PWH who exhibit comparable cross-sectional neurocognitive performance to that of a healthy 25-year-old (estimated ~ 17% of older PWH) [21] Compared to their cognitively average and cognitively impaired counterparts with HIV, these SA with HIV exhibit better functioning on key biopsychosocial indicators, including less comorbidity burden and self-reported cognitive and depressive symptoms, as well as higher levels of cognitive reserve. GMM is a person-centered approach that facilitates the identification of latent longitudinal classes, which account for unobserved intercept and slope heterogeneity in the entire sample, and predictors can be specified in GMM to explain inter-class differences in neurocognitive change [22, 23] Within this GMM framework, we examined the degree to which baseline SuperAging classifications and baseline indicators of biopsychosocial health at baseline (e.g., cognitive reserve, physiologic reserve, depression) converged with longitudinal classes of neurocognitive aging in PWH. We expected individuals with better baseline biopsychosocial functioning to have higher odds of membership in better longitudinal class(es)
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