Higher Comorbidity Burden Predicts Worsening Neurocognitive Trajectories in People with Human Immunodeficiency Virus.
Title | Higher Comorbidity Burden Predicts Worsening Neurocognitive Trajectories in People with Human Immunodeficiency Virus. |
Publication Type | Journal Article |
Year of Publication | 2022 |
Authors | Ellis, RJ, Paolillo, E, Saloner, R, Heaton, RK |
Journal | Clin Infect Dis |
Volume | 74 |
Issue | 8 |
Pagination | 1323-1328 |
Date Published | 2022 Apr 28 |
ISSN | 1537-6591 |
Keywords | CHARTER, Internal |
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. |
DOI | 10.1093/cid/ciab655 |
Alternate Journal | Clin Infect Dis |
PubMed ID | 34329400 |
PubMed Central ID | PMC9049252 |
Grant List | U24 MH100929 / MH / NIMH NIH HHS / United States U24 MH100925 / MH / NIMH NIH HHS / United States P50 DA026306 / DA / NIDA NIH HHS / United States U24 MH100931 / MH / NIMH NIH HHS / United States U24 MH100928 / MH / NIMH NIH HHS / United States P30 MH062512 / MH / NIMH NIH HHS / United States F31 AG064989 / AG / NIA NIH HHS / United States R01 MH107345 / MH / NIMH NIH HHS / United States U24 MH100930 / MH / NIMH NIH HHS / United States |