Declining Prevalence of Human Immunodeficiency Virus (HIV)-Associated Neurocognitive Disorders in Recent Years and Associated Factors in a Large Cohort of Antiretroviral Therapy-Treated Individuals With HIV
Overview
Authors
Affiliations
Background: HIV-associated neurocognitive disorders (HAND) have been suggested as persistent even with effective antiretroviral therapy (ART). Aims were to evaluate HAND prevalence and associated factors, in a large cohort of people-with-HIV (PWH).
Methods: ART-treated PWH, underwent a neuropsychological examination through a battery of 12 tests exploring 5 different domains, between 2009 and 2020, were included in this cross-sectional analysis. HAND were classified according to Frascati's criteria. Participants were defined as complaining or not-complaining if a cognitive complaint was reported or not. Chi-square for trend and multivariable logistic regression were fitted.
Results: Overall, 1424 PWH were enrolled during four three-years periods. HAND prevalence was 24%; among complainers (572/1424), it was 38%, higher than among not-complainers (15%). Over the study period, a decreasing HAND prevalence was found in the entire population (P < 0.001) and in complaining (P < 0.001); in not-complaining it remained stable (P = 0.182). Factors associated with HAND were older age, lower educational level, lower current CD4+ T-cell count and HCV co-infection. Compared to nonnucleoside reverse transcriptase inhibitors, receiving dual and integrase strand transfer inhibitor (INSTI)-based therapies was associated with a decreased risk of HAND, as well as being tested in more recent years.
Conclusions: In this large cohort of ART-treated PWH, mostly virologically suppressed, a remarkable decreasing HAND prevalence was observed. Besides HIV- and patient-related factors, the reduced risk of HAND found with dual and INSTI-based regimens along with a more recent ART initiation, could suggest a potential role of new treatment strategies in this decline, due to their greater virologic efficacy and better tolerability.
Cai D, Song P, Song F, Shi Y Sci Rep. 2025; 15(1):5808.
PMID: 39962187 PMC: 11833122. DOI: 10.1038/s41598-025-89388-0.
Risk factors for cognitive decline in persons with HIV.
Henderson M, Winston A Curr Opin Infect Dis. 2024; 38(1):37-43.
PMID: 39641182 PMC: 11676619. DOI: 10.1097/QCO.0000000000001080.
HIV transcription persists in the brain of virally suppressed people with HIV.
Jamal Eddine J, Angelovich T, Zhou J, Byrnes S, Tumpach C, Saraya N PLoS Pathog. 2024; 20(8):e1012446.
PMID: 39116185 PMC: 11335163. DOI: 10.1371/journal.ppat.1012446.
Liu Z, Julius P, Mudenda V, Kang G, Del Valle L, West J J Neurovirol. 2024; 30(3):303-315.
PMID: 38943022 DOI: 10.1007/s13365-024-01219-6.
Brkic-Jovanovic N, Karaman M, Andric V, Maric D, Brkic S, Bugarski-Ignjatovic V PLoS One. 2024; 19(6):e0306278.
PMID: 38923982 PMC: 11207154. DOI: 10.1371/journal.pone.0306278.