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. 2023 Aug 1;37(10):1565-1571.
doi: 10.1097/QAD.0000000000003595. Epub 2023 May 9.

Cognitive concerns are a risk factor for mortality in people with HIV and coronavirus disease 2019

Douglas R Wilcox  1   2   3 , Emily A Rudmann  4   5 , Elissa Ye  1 , Ayush Noori  1 , Colin Magdamo  1 , Aayushee Jain  1 , Haitham Alabsi  1   3 , Brody Foy  6 , Virginia A Triant  7   8 , Gregory K Robbins  7 , M Brandon Westover  1   3 , Sudeshna Das  1   3 , Shibani S Mukerji  4   5
Affiliations

Cognitive concerns are a risk factor for mortality in people with HIV and coronavirus disease 2019

Douglas R Wilcox et al. AIDS. .

Abstract

Background: Data supporting dementia as a risk factor for coronavirus disease 2019 (COVID-19) mortality relied on ICD-10 codes, yet nearly 40% of individuals with probable dementia lack a formal diagnosis. Dementia coding is not well established for people with HIV (PWH), and its reliance may affect risk assessment.

Methods: This retrospective cohort analysis of PWH with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR positivity includes comparisons to people without HIV (PWoH), matched by age, sex, race, and zipcode. Primary exposures were dementia diagnosis, by International Classification of Diseases (ICD)-10 codes, and cognitive concerns, defined as possible cognitive impairment up to 12 months before COVID-19 diagnosis after clinical review of notes from the electronic health record. Logistic regression models assessed the effect of dementia and cognitive concerns on odds of death [odds ratio (OR); 95% CI (95% confidence interval)]; models adjusted for VACS Index 2.0.

Results: Sixty-four PWH were identified out of 14 129 patients with SARS-CoV-2 infection and matched to 463 PWoH. Compared with PWoH, PWH had a higher prevalence of dementia (15.6% vs. 6%, P = 0.01) and cognitive concerns (21.9% vs. 15.8%, P = 0.04). Death was more frequent in PWH ( P < 0.01). Adjusted for VACS Index 2.0, dementia [2.4 (1.0-5.8), P = 0.05] and cognitive concerns [2.4 (1.1-5.3), P = 0.03] were associated with increased odds of death. In PWH, the association between cognitive concern and death trended towards statistical significance [3.92 (0.81-20.19), P = 0.09]; there was no association with dementia.

Conclusion: Cognitive status assessments are important for care in COVID-19, especially among PWH. Larger studies should validate findings and determine long-term COVID-19 consequences in PWH with preexisting cognitive deficits.

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Conflict of interest statement

H.A. is current employed at Biogen. G.K.R. has received trial support from Leonard Meron Biosciences, been a consultant to Teradyne Inc and SEED Inc, is a member of the DHHS OI guideline review panel. M.B.W. is the co-founder of Beacon Biosignals.

Figures

Fig. 1
Fig. 1
VACS Index 2.0 correlates with level of care and mortality from coronavirus disease 2019 both in the full cohort (a) and separated by HIV status (b).
Fig. 2
Fig. 2
Cognitive concerns in people with HIV and people without HIV increase the odds ratios for death after coronavirus disease 2019.
See this image and copyright information in PMC

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