Ethnic/Racial Disparities in Longitudinal Neurocognitive Decline in People With HIV

Abstract

Background: To examine longitudinal neurocognitive decline among Latino, non-Latino Black, and non-Latino White people with HIV (PWH) and factors that may explain ethnic/racial disparities in neurocognitive decline.

Methods: Four hundred ninety nine PWH (13.8% Latino, 42.7% Black, 43.5% White; baseline age: M = 43.5) from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study completed neurocognitive, neuromedical, and laboratory assessments every 6-12 months with up to 5 years of follow-up. Longitudinal neurocognitive change was determined via published regression-based norms. Survival analyses investigated the relationship between ethnicity/race and neurocognitive change, and baseline and time-dependent variables that may explain ethnic/racial disparities in neurocognitive decline, including socio-demographic, HIV-disease, medical, psychiatric, and substance use characteristics.

Results: In Cox proportional hazard models, hazard ratios for neurocognitive decline were increased for Latino compared with White PWH (HR = 2.25, 95% CI = 1.35 to 3.73, P = 0.002), and Latino compared with Black PWH (HR = 1.86, 95% CI = 1.14 to 3.04, P = 0.013), with no significant differences between Black and White PWH (P = 0.40). Comorbidities, including cardiometabolic factors and more severe neurocognitive comorbidity classification, accounted for 33.6% of the excess hazard for Latino compared with White PWH, decreasing the hazard ratio associated with Latino ethnicity (HR = 1.83, 95% CI = 1.06 to 3.16, P = 0.03), but did not fully account for elevated risk of decline.

Conclusions: Latino PWH may be at higher risk of early neurocognitive decline compared with Black and White PWH. Comorbidities accounted for some, but not all, of this increased risk among Latino PWH. Future research examining institutional, sociocultural, and biomedical factors, including structural discrimination and age-related biomarkers, may further explain the observed disparities.

Figure 1.

Neurocognitive change (decline, stable, improve) by ethnicity/race. The overall model showed significant ethnic/racial differences in the proportion of participants who declined, remained stable, or improved neurocognitively (χ² = 11.84, df = 4, p = 0.019). Latino PWH were at higher risk of neurocognitive decline compared to White (χ² = 10.24, df = 1, p = 0.001) and Black (χ² = 5.59, df = 1, p = 0.018) PWH, while Black and White PWH did not differ (χ² = 0.91, df = 1, p = 0.34).

Figure 2.

Neurocognitive decline over study follow-up by ethnicity/race. In a Kaplan-Meier survival analysis, the pattern of decline over years of follow-up differed significantly by ethnicity/race (p = 0.005). In pairwise log-rank tests, Latino PWH declined faster and had a higher proportion of neurocognitive decliners compared to White (HR = 2.24, 95% CI 1.24–4.05, p = 0.001) and Black (HR = 1.86, 95% CI 1.07–3.25, p = 0.01) PWH. Black and White PWH showed similar trajectories of neurocognitive decline over study follow-up (HR = 1.21, 95% CI 0.78–1.87, p = 0.40).