Abstract
HIV-related neurocognitive impairment (NCI) may increase the risk of death. However, a survival disadvantage for patients with NCI has not been well studied in the post-combination antiretroviral therapy (cART) era. Specifically, limited research has been conducted considering the reversible nature and variable progression of the impairment and this area demands further evaluation. We performed multivariable Cox proportional hazards modeling to assess the association between baseline NCI (global T scores) and mortality. A joint modeling approach was then used to model the trajectory of global neurocognitive functioning over time and the association between neurocognitive trajectory and mortality. Among the National NeuroAIDS Tissue Consortium’s (NNTC) HIV-infected participants, we found a strong negative association between NCI and mortality in the older age groups (e.g., at age = 55, HR = 0.79; 95% CI 0.64–0.99). Three neurocognitive sub-domains (abstraction and executive functioning, speed of information processing, and motor) had the strongest negative association with mortality. Joint modelling indicated a 33% lower hazard for every 10-unit increase in global T scores (HR = 0.67; 95% CI 0.56–0.80). The study identified older HIV-infected individuals with NCI as a group needing special attention for the longevity of life. The study has considerable prognostic utility by not only predicting mortality hazard, but also future cognitive status.
Highlights
human immunodeficiency virus (HIV)-related neurocognitive impairment (NCI) may increase the risk of death
HIV related morbidity and mortality have decreased over time, people living with HIV continue to face an increased risk of mortality compared to the non-infected counterparts, even among those with a successful response to combination antiretroviral therapy (cART)16,17
78% of participants were on a highly active antiretroviral therapy (HAART) regimen, 13% were on the non-HAART regimen, and the rest 9% were not using any antiretroviral therapy (ART)
Summary
HIV-related neurocognitive impairment (NCI) may increase the risk of death. Despite the widespread use of cART, HIV-associated neurocognitive impairment (NCI) and brain injury persist with a change in phenotype and pattern. HIV infected individuals with mild cognitive impairment may have an increased risk of dementia and death[14,15]. HIV related morbidity and mortality have decreased over time, people living with HIV continue to face an increased risk of mortality compared to the non-infected counterparts, even among those with a successful response to cART16,17. Three other studies conducted in the cART era found a positive association between NCI and mortality but were limited to participants with advanced HIV infection or severe cognitive disorders only[24,25,26]. Studies have demonstrated inconsistent results pertaining to the ability of HDS to detect subtle types of N CI28,29
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