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. 2023 Jun;71(6):1861-1872.
doi: 10.1111/jgs.18265. Epub 2023 Feb 14.

Delirium among people aging with and without HIV: Role of alcohol and Neurocognitively active medications

Kathleen M Akgün  1   2 , Supriya Krishnan  2 , Janet Tate  1   2 , Kendall Bryant  3 , Margaret A Pisani  2 , Vincent Lo Re 3rd  4 , Christopher T Rentsch  1   2   5 , Kristina Crothers  6   7 , Kirsha S Gordon  1   2 , Amy C Justice  1   2   8 ; VACS project team
Affiliations

Delirium among people aging with and without HIV: Role of alcohol and Neurocognitively active medications

Kathleen M Akgün et al. J Am Geriatr Soc. 2023 Jun.

Abstract

Background: People aging with and without HIV (PWH and PWoH) want to avoid neurocognitive dysfunction, especially delirium. Continued use of alcohol in conjunction with neurocognitively active medications (NCAMs) may be a largely underappreciated cause, especially for PWH who experience polypharmacy a decade earlier than PWoH. We compare absolute and relative risk of delirium among PWH and PWoH by age, level of alcohol use, and exposure to NCAMs.

Methods: Using the VACS cohort, we compare absolute and relative risk of inpatient delirium among PWH and PWoH by age, level of alcohol use, and exposure to NCAMs between 2007 and 2019. We matched each case based on age, race/ethnicity, sex, HIV, baseline year, and observation time with up to 5 controls. The case/control date was defined as date of admission for cases and the date corresponding to the same length of time on study for controls. Level of alcohol use was defined using Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). Medication exposure was measured from 45 to 3 days prior to index date; medications were classified as anticholinergic NCAM, non-anticholinergic NCAM, or non NCAM and counts generated. We used logistic regression to determine odds ratios (ORs) for delirium associated with medication counts stratified by HIV status and adjusted for demographics, severity of illness, and related diagnoses.

Results: PWH experienced a higher incidence of delirium (5.6, [95% CI 5.3-5.9/1000 PY]) than PWoH (5.0, [95% CI 4.8-5.1/1000 PY]). In multivariable analysis, anticholinergic and non-anticholinergic NCAM counts and level of alcohol use demonstrated strong independent dose-response associations with delirium.

Conclusions: Decreasing alcohol use and limiting the use of neurocognitively active medications may help decrease excess rates of delirium, especially among PWH.

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Figures

Figure 1.
Figure 1.
Delirium Incidence per /1000 person years, by HIV status. PWH = People with HIV; PWoH = People without HIV.
Figure 2.
Figure 2.
Multivariable association of medications and alcohol use patterns with incident, inpatient delirium; stratified by HIV status, adjusted for age, sex, race, severity of illness. Red triangle = People with HIV; Blue circle = People without HIV; NCAM = neurocognitively active medication; AC = anticholinergic; Non-AC = non-anticholinergic; AUDIT-C = Alcohol Use Disorder Test, Consumption; lower 1-3 men, 1-2 women; moderate 4-5 men, 3-5 women; high 6+; AUD = alcohol use disorder.
Figure 3.
Figure 3.
Multivariable association showing additive effects of medications and alcohol use patterns with incident, inpatient delirium; stratified by HIV status and history of alcohol use disorder (AUD), adjusted for age, sex, race, severity of illness. Red triangle = People with HIV; Blue circle = People without HIV; NCAM = neurocognitively active medication; AC = anticholinergic; Non-AC = non-anticholinergic; AUDIT-C = Alcohol Use Disorder Test, Consumption; lower 1-3 men, 1-2 women; moderate 4-5 men, 3-5 women; high 6+
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