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

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.

Figure 1.

Human immunodeficiency virus–associated neurocognitive disorder prevalence for the entire study population, complaining and not-complaining patients. Abbreviations: ANI, asymptomatic neurocognitive impairment; HAD, human immunodeficiency virus–associated dementia; MND, mild neurocognitive disorder.

Figure 2.

HAND prevalence according to calendar period of neuropsychological assessment for the entire study population (A), complaining patients (B), and not-complaining patients (C). P values at χ² for trend are shown. Abbreviations: ANI, asymptomatic neurocognitive impairment; HAD, human immunodeficiency virus–associated dementia; HAND, human immunodeficiency virus–associated neurocognitive disorder; MND, mild neurocognitive disorder.

Figure 3.

Human immunodeficiency virus–associated neurocognitive disorder prevalence for the entire study population according to calendar period of neuropsychological assessment (NPA), after stratifying for age (A), mode of HIV transmission (B), nadir (C) and current CD4⁺ T-cell count (D), and HIV-RNA at NPA (E). P values at Chi square for trend are shown. *P value <.001 at χ² for trend. ** = .013, *** = .068, **** = .002. Abbreviations: HIV, human immunodeficiency virus; IVDU, intravenous drug user; MSM, men who have sex with men.