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

Ilaria Mastrorosa; Carmela Pinnetti; Anna Clelia Brita; Annalisa Mondi; Patrizia Lorenzini; Giulia Del Duca; Alessandra Vergori; Valentina Mazzotta; Roberta Gagliardini; Marta Camici; Federico De Zottis; Marisa Fusto; Maria Maddalena Plazzi; Elisabetta Grilli; Rita Bellagamba; Stefania Cicalini; Andrea Antinori

doi:10.1093/cid/ciac658

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

Clin Infect Dis. 2023 Feb 8;76(3):e629-e637. doi: 10.1093/cid/ciac658.

Authors

Ilaria Mastrorosa¹, Carmela Pinnetti¹, Anna Clelia Brita², Annalisa Mondi¹, Patrizia Lorenzini^{1

3}, Giulia Del Duca¹, Alessandra Vergori¹, Valentina Mazzotta¹, Roberta Gagliardini¹, Marta Camici¹, Federico De Zottis¹, Marisa Fusto¹, Maria Maddalena Plazzi¹, Elisabetta Grilli¹, Rita Bellagamba¹, Stefania Cicalini¹, Andrea Antinori¹

Affiliations

¹ Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
² Clinical Department of Infectious Diseases and Research, Psychology Service, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
³ National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy.

Abstract

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.

Keywords: AIDS; HIV; HIV-associated neurocognitive disorders (HAND); integrase strand transfer inhibitor; neurocognitive impairment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
HIV Infections* / complications
HIV Infections* / drug therapy
HIV Infections* / epidemiology
HIV*
Humans
Neurocognitive Disorders / epidemiology
Prevalence