Alain Makinson1,2, Jonathan Dubois3, Sabrina Eymard-Duvernay2, Pascale Leclercq4, Olivia Zaegel-Faucher5, Louis Bernard6, Matteo Vassallo7, Claudine Barbuat8, Christian Gény9, Eric Thouvenot10, Dominique Costagliola11, Anna Ozguler12, Marie Zins12, Mélanie Simony13, Jacques Reynes1,2, Claudine Berr3. 1. Infectious and Tropical Diseases Department, University Hospital Montpellier, and Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin, Université Grenoble Alpes, Marseille. 2. Institut de Recherche et Développement, and Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin, Université Grenoble Alpes;, Institut National de la Santé et de la Recherche Médicale (French Institute of Health and Medical Research) (INSERM), University of Montpellier TransVIHMI Unit, Marseille. 3. INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, and Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin, Université Grenoble Alpes, Marseille. 4. Infectious Disease Unit, University Hospital of Grenobles Alpes, and Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin, Université Grenoble Alpes, Marseille. 5. Clinical Immuno-Hematology Department, Aix-Marseille University, Sainte-Marguerite University Hospital, Marseille. 6. Infectious Diseases Unit, University Hospital Tours, Nîmes. 7. Department of Internal Medicine, Cannes General Hospital, Nîmes. 8. Infectious Diseases Department, University Hospital, Nîmes. 9. Neurology Department, Montpellier University Hospital Center, Gui de Chauliac Hospital, Nîmes. 10. Neurology Department, University Hospital, Nîmes. 11. Sorbonne University, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France. 12. INSERM, Paris Descartes University Population-based Epidemiological Cohorts Unit, Villejuif, France. 13. ANRS (France Recherche Nord & Sud Sida-HIV Hépatites), Unit for Basic and Clinical Research on Viral Hepatitis and HIV, Paris, France.
Abstract
BACKGROUND: There are limited data on the comparative prevalence of neurocognitive impairment (NCI) in aging people living with human immunodeficiency virus (PLHIV) and people not living with HIV. METHODS: This was a cross-sectional study of PLHIV randomly matched by age (±4 years), gender, and education with 5 HIV-uninfected individuals from the CONSTANCES cohort. PLHIV were fluent in French and sequentially included during routine outpatient visits if aged 55-70 years, with HIV viral load <50 copies/mL, and lymphocyte T-CD4 level ≥200 cells/µL in the past 24 and 12 months, respectively. The primary outcome was NCI as defined by the Frascati criteria. Multivariate normative comparison (MNC) and -1.5 standard deviations in ≥2 neurocognitive domains were secondary outcomes of NCI. RESULTS: Two hundred PLHIV were matched with 1000 controls. Median age was 62 years, and 85% were men. In PLHIV, the median T-CD4 lymphocyte level was 650 cells/µL, and median nadir T-CD4 lymphocyte level was 176 cells/µL. NCI was found in 71 (35.5%) PLHIV and in 242 (24.2%) controls (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.25, 2.41). After adjusting for confounders, HIV remained significantly associated with NCI (OR, 1.50; 95% CI, 1.04, 2.16). Adjusted results were similar with NCI defined by MNC (ORMNC, 2.95; 95% CI, 1.13, 3.50) or -1.5 SD (OR-1.5, 2.24; 95% CI, 1.39, 3.62). CONCLUSIONS: In this matched study of aging individuals, HIV was significantly associated with an increased risk of NCI after adjusting for major confounders. Results were confirmed with more stringent NCI classifications. CLINICAL TRIALS REGISTRATION: NCT02592174.
BACKGROUND: There are limited data on the comparative prevalence of neurocognitive impairment (NCI) in aging people living with human immunodeficiency virus (PLHIV) and people not living with HIV. METHODS: This was a cross-sectional study of PLHIV randomly matched by age (±4 years), gender, and education with 5 HIV-uninfected individuals from the CONSTANCES cohort. PLHIV were fluent in French and sequentially included during routine outpatient visits if aged 55-70 years, with HIV viral load <50 copies/mL, and lymphocyte T-CD4 level ≥200 cells/µL in the past 24 and 12 months, respectively. The primary outcome was NCI as defined by the Frascati criteria. Multivariate normative comparison (MNC) and -1.5 standard deviations in ≥2 neurocognitive domains were secondary outcomes of NCI. RESULTS: Two hundred PLHIV were matched with 1000 controls. Median age was 62 years, and 85% were men. In PLHIV, the median T-CD4 lymphocyte level was 650 cells/µL, and median nadir T-CD4 lymphocyte level was 176 cells/µL. NCI was found in 71 (35.5%) PLHIV and in 242 (24.2%) controls (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.25, 2.41). After adjusting for confounders, HIV remained significantly associated with NCI (OR, 1.50; 95% CI, 1.04, 2.16). Adjusted results were similar with NCI defined by MNC (ORMNC, 2.95; 95% CI, 1.13, 3.50) or -1.5 SD (OR-1.5, 2.24; 95% CI, 1.39, 3.62). CONCLUSIONS: In this matched study of aging individuals, HIV was significantly associated with an increased risk of NCI after adjusting for major confounders. Results were confirmed with more stringent NCI classifications. CLINICAL TRIALS REGISTRATION: NCT02592174.
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