Higher Comorbidity Burden Predicts Worsening Neurocognitive Trajectories in People with Human Immunodeficiency Virus
Year: 2021
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Age-related comorbidities accumulate faster in people with HIV (PWH) than in those without HIV. We evaluated whether a validated multimorbidity scale, the Charlson index, predicted neurocognitive trajectories in PWH. METHODS: Scaled scores of a comprehensive neuropsychological battery were averaged across all visits. Multilevel modeling examined between- and within-person predictors of global neurocognition. At the between-person level, averaged Charlson scores were examined as a predictor of neurocognitive change rate, covarying for HIV disease characteristics. Within-persons, visit-specific Charlson index was used to predict fluctuations in global neurocognition at the same and next visit, covarying for disease measures. RESULTS: Participants were 1195 PWH (mean baseline age: 43.0; SD: 9.7 years) followed for a mean of 7.1 years (range: 0.5-20.5). At the between-person level, more rapid neurocognitive worsening correlated with higher (worse) average Charlson scores (standardized β: -0.062; SE: 0.015; P = .001) and lower CD4 nadir (standardized β: 0.055; SE: 0.021; P = .011), but not viral suppression or average CD4+ lymphocytes (P > .05). At the within-person level, poorer visit-specific neurocognition was related to worse concurrent, but not preceding, Charlson scores (standardized β: -0.046; SE: 0.015; P = .003), detectable HIV viral load (standardized β: 0.018; SE: 0.006; P = .001), and higher CD4+ (standardized β: 0.043; SE: 0.009; P < .001). CONCLUSIONS: The impact of comorbidities on neurocognitive decline exceeded that of HIV disease factors. Although correlative, the temporal relationships suggested that treatment of comorbidities might improve neurocognitive prognosis for PWH.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciab655
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: bronze
Funders: U.S. Department of Veterans Affairs, University of California, San Diego, Veterans Affairs San Diego Healthcare System, National Institute on Aging, National Institute of Mental Health, National Institute on Drug Abuse, National Institute of Neurological Disorders and Stroke, HIV Neurobehavioral Research Center, University of California, San Diego
Awards: G130322559, G1353012146, G1673230823, G1910588693, Translational Methamphetamine AIDS Research Center (TMARC), California NeuroAIDS Tissue Network, G3350118538, G3471390838, G3550442147, G3611395682, G3869176401, G4559771646, G5641659859, Texas NeuroAIDS Research Center, G645235059, HIV Neurobehavioral Research Center
OpenAlex ID: W3186932379