Meaningful cognitive decline is uncommon in virally suppressed HIV, but sustained impairment, subtle decline and abnormal cognitive aging are notResearch in context
Summary: Background: High antiretroviral therapy (ART) coverage and viral suppression among people with HIV (PWH) in Australia provide a unique context to study individual cognitive trajectories, cognitive aging and factors associated with longitudinal cognitive function during chronic and stable H...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-02-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537022005211 |
| _version_ | 1797895559076380672 |
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| author | Htein Linn Aung Krista J. Siefried Thomas M. Gates Bruce J. Brew Limin Mao Andrew Carr Lucette A. Cysique |
| author_facet | Htein Linn Aung Krista J. Siefried Thomas M. Gates Bruce J. Brew Limin Mao Andrew Carr Lucette A. Cysique |
| author_sort | Htein Linn Aung |
| collection | DOAJ |
| description | Summary: Background: High antiretroviral therapy (ART) coverage and viral suppression among people with HIV (PWH) in Australia provide a unique context to study individual cognitive trajectories, cognitive aging and factors associated with longitudinal cognitive function during chronic and stable HIV disease. Methods: Participants from the Predictors of Adherence to Antiretroviral Therapy study (n = 457, recruited between September 2013 and November 2015, median age = 52 years, and all with HIV RNA <50 copies mL) completed a cognitive assessment with CogState Computerized Battery (CCB) at baseline, Month-12, and Month-24. Demographics, psycho-social and socioeconomic factors, healthcare seeking behaviors, HIV disease characteristics and comorbidities were assessed. The CCB data were corrected for age, sex and practice effect and averaged into a global z-score (GZS). Cognitive impairment was defined with the global deficit score method (GDS>0.5). Meaningful cognitive change was statistically defined (decline or improvement versus stability, i.e., 90% CI, that is p < 0.05, 2-tailed) using a novel evidence-based change score: the linear mixed-effect regression (LMER)-based GZS change score. A separate LMER model with a top-down variable selection approach identified the independent effects of age and other demographic, HIV disease characteristics, socioeconomic and health-related factors on the demographically corrected GZS. The combined definitions of change and cross-sectional impairment enabled the identification of cognitive trajectories. Findings: At Month-12 and Month-24, 6% and 7% showed meaningful cognitive decline and 4% and 3% improved respectively. Only 1% showed sustained decline. Incident impairment due to subtle cognitive decline (i.e., below the threshold of meaningful cognitive decline) was 31% and 25% at Month-12 and Month-24, while 14% showed sustained impairment (i.e., cognitively impaired at all study visits). Older age (≥50 years) and time interaction was associated with lower demographically corrected GZS (β = −0.31, p < 0.001). Having a regular relationship, excellent English proficiency, and perceived stigma (avoidance) were associated with higher GZS (all p < 0.05). Relying on government subsidy, severe depression, and lower belief in ART necessity and higher concerns were associated with lower GZS (all p < 0.05). No HIV disease characteristics had a significant effect. Interpretations: Meaningful cognitive decline was not different from normal expectation in chronic stable HIV disease. Despite this, subtle cognitive decline, sustained cognitive impairment, and greater than normative-age cognitive aging were evident. Funding: Funding for the PAART study was provided in part by unrestricted educational grants from Gilead Sciences (www.gilead.com) (Grant Number: IN-AU-264- 0131), the Balnaves Foundation (www.balnavesfoundation.com), the Victorian Department of Health and Human Services (Australia) (www.dhs.vic.gov.au/home), Western Australia Health (www.health.wa.gov.au), the ACT Ministry of Health (Australia) (www.health.act.gov.au), and in-kind support from the Queensland Department of Health (Australia) (www.health.qld.gov.au), and NHMRC Partnership grant APP1058474 (PI: Carr, Andrew). |
| first_indexed | 2024-04-10T07:27:44Z |
| format | Article |
| id | doaj.art-9919c113f0754ddf82f391e6a35776ff |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-10T07:27:44Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-9919c113f0754ddf82f391e6a35776ff2023-02-24T04:31:15ZengElsevierEClinicalMedicine2589-53702023-02-0156101792Meaningful cognitive decline is uncommon in virally suppressed HIV, but sustained impairment, subtle decline and abnormal cognitive aging are notResearch in contextHtein Linn Aung0Krista J. Siefried1Thomas M. Gates2Bruce J. Brew3Limin Mao4Andrew Carr5Lucette A. Cysique6St Vincent's Centre for Applied Medical Research, Sydney, Australia; Faculty of Medicine, UNSW, AustraliaSt Vincent's Centre for Applied Medical Research, Sydney, Australia; Immunology and HIV Unit, St Vincent's Hospital, Sydney, Australia; The National Centre for Clinical Research on Emerging Drugs, Sydney, AustraliaSt Vincent's Centre for Applied Medical Research, Sydney, Australia; Departments of Neurology and HIV Medicine, St Vincent's Hospital, AustraliaSt Vincent's Centre for Applied Medical Research, Sydney, Australia; Faculty of Medicine, UNSW, Australia; Departments of Neurology and HIV Medicine, St Vincent's Hospital, Australia; Faculty of Medicine, University of Notre Dame, Sydney, AustraliaCentre for Social Research in Health, UNSW, Sydney, AustraliaSt Vincent's Centre for Applied Medical Research, Sydney, Australia; Immunology and HIV Unit, St Vincent's Hospital, Sydney, AustraliaSt Vincent's Centre for Applied Medical Research, Sydney, Australia; Departments of Neurology and HIV Medicine, St Vincent's Hospital, Australia; School of Psychology, University of New South Wales, Sydney, NSW, Australia; Corresponding author. School of Psychology, The University of New South Wales, Matthews Building, Room 1012, 11 Botany Street, Sydney, NSW, 2052, Australia.Summary: Background: High antiretroviral therapy (ART) coverage and viral suppression among people with HIV (PWH) in Australia provide a unique context to study individual cognitive trajectories, cognitive aging and factors associated with longitudinal cognitive function during chronic and stable HIV disease. Methods: Participants from the Predictors of Adherence to Antiretroviral Therapy study (n = 457, recruited between September 2013 and November 2015, median age = 52 years, and all with HIV RNA <50 copies mL) completed a cognitive assessment with CogState Computerized Battery (CCB) at baseline, Month-12, and Month-24. Demographics, psycho-social and socioeconomic factors, healthcare seeking behaviors, HIV disease characteristics and comorbidities were assessed. The CCB data were corrected for age, sex and practice effect and averaged into a global z-score (GZS). Cognitive impairment was defined with the global deficit score method (GDS>0.5). Meaningful cognitive change was statistically defined (decline or improvement versus stability, i.e., 90% CI, that is p < 0.05, 2-tailed) using a novel evidence-based change score: the linear mixed-effect regression (LMER)-based GZS change score. A separate LMER model with a top-down variable selection approach identified the independent effects of age and other demographic, HIV disease characteristics, socioeconomic and health-related factors on the demographically corrected GZS. The combined definitions of change and cross-sectional impairment enabled the identification of cognitive trajectories. Findings: At Month-12 and Month-24, 6% and 7% showed meaningful cognitive decline and 4% and 3% improved respectively. Only 1% showed sustained decline. Incident impairment due to subtle cognitive decline (i.e., below the threshold of meaningful cognitive decline) was 31% and 25% at Month-12 and Month-24, while 14% showed sustained impairment (i.e., cognitively impaired at all study visits). Older age (≥50 years) and time interaction was associated with lower demographically corrected GZS (β = −0.31, p < 0.001). Having a regular relationship, excellent English proficiency, and perceived stigma (avoidance) were associated with higher GZS (all p < 0.05). Relying on government subsidy, severe depression, and lower belief in ART necessity and higher concerns were associated with lower GZS (all p < 0.05). No HIV disease characteristics had a significant effect. Interpretations: Meaningful cognitive decline was not different from normal expectation in chronic stable HIV disease. Despite this, subtle cognitive decline, sustained cognitive impairment, and greater than normative-age cognitive aging were evident. Funding: Funding for the PAART study was provided in part by unrestricted educational grants from Gilead Sciences (www.gilead.com) (Grant Number: IN-AU-264- 0131), the Balnaves Foundation (www.balnavesfoundation.com), the Victorian Department of Health and Human Services (Australia) (www.dhs.vic.gov.au/home), Western Australia Health (www.health.wa.gov.au), the ACT Ministry of Health (Australia) (www.health.act.gov.au), and in-kind support from the Queensland Department of Health (Australia) (www.health.qld.gov.au), and NHMRC Partnership grant APP1058474 (PI: Carr, Andrew).http://www.sciencedirect.com/science/article/pii/S2589537022005211HIVNeurocognitionTrajectoriesAgingPsychosocial factors |
| spellingShingle | Htein Linn Aung Krista J. Siefried Thomas M. Gates Bruce J. Brew Limin Mao Andrew Carr Lucette A. Cysique Meaningful cognitive decline is uncommon in virally suppressed HIV, but sustained impairment, subtle decline and abnormal cognitive aging are notResearch in context EClinicalMedicine HIV Neurocognition Trajectories Aging Psychosocial factors |
| title | Meaningful cognitive decline is uncommon in virally suppressed HIV, but sustained impairment, subtle decline and abnormal cognitive aging are notResearch in context |
| title_full | Meaningful cognitive decline is uncommon in virally suppressed HIV, but sustained impairment, subtle decline and abnormal cognitive aging are notResearch in context |
| title_fullStr | Meaningful cognitive decline is uncommon in virally suppressed HIV, but sustained impairment, subtle decline and abnormal cognitive aging are notResearch in context |
| title_full_unstemmed | Meaningful cognitive decline is uncommon in virally suppressed HIV, but sustained impairment, subtle decline and abnormal cognitive aging are notResearch in context |
| title_short | Meaningful cognitive decline is uncommon in virally suppressed HIV, but sustained impairment, subtle decline and abnormal cognitive aging are notResearch in context |
| title_sort | meaningful cognitive decline is uncommon in virally suppressed hiv but sustained impairment subtle decline and abnormal cognitive aging are notresearch in context |
| topic | HIV Neurocognition Trajectories Aging Psychosocial factors |
| url | http://www.sciencedirect.com/science/article/pii/S2589537022005211 |
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