Galia Santos1, Isabella Locatelli2, Mélanie Métral3, Alexandre Berney4, Isaure Nadin3,5, Alexandra Calmy6, Philip Tarr7, Klemens Gutbrod8, Christoph Hauser9, Peter Brugger10, Helen Kovari11, Ursi Kunze12, Marcel Stoeckle13, Severin Früh14, Patrick Schmid15, Stefania Rossi16, Caroline Di Benedetto17, Renaud Du Pasquier18, Katharine Darling1, Matthias Cavassini1. 1. Infectious Diseases Service, 30635Lausanne University Hospital, Lausanne, Switzerland. 2. Division of biostatistics and quantitative methods, Institute of Social and Preventive Medicine, 30640Lausanne University Hospital, Lausanne, Switzerland. 3. Laboratory of neuroimmunology, Research Centre of clinical neurosciences, Department of clinical neurosciences, 419233Lausanne University Hospital, Lausanne, Switzerland. 4. Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland. 5. Department of Neurology, 27230Geneva University Hospital, University of Geneva, Geneva, Switzerland. 6. HIV unit, Infectious Diseases Division, Medicine Specialties Department, Geneva University Hospital, University of Geneva, Geneva, Switzerland. 7. University Department of Medicine, Kantonsspital Bruderholz, 27209University of Basel, Bruderholz, Basel, Switzerland. 8. Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital Bern, Bern, Switzerland. 9. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland. 10. Department of Neuropsychology, Neurology Clinic, 27243University Hospital Zürich, Zürich, Switzerland. 11. Department of Infectious Diseases and Hospital Epidemiology, Universitätsspital Zurich, University of Zurich, Zurich, Switzerland. 12. Memory Clinic, University Centre for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland. 13. Division of Infectious Diseases and Hospital Epidemiology, 30262University Hospital Basel, University of Basel, Basel, Switzerland. 14. Department of Neurology, Neuropsychology Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland. 15. Infectious Diseases and Hospital Epidemiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland. 16. Neuropsychology Unit, 30721Lugano Regional Hospital, Lugano, Switzerland. 17. Infectious Diseases Division, 30721Lugano Regional Hospital, Lugano, Switzerland. 18. Service of Neurology, Department of clinical neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
Abstract
BACKGROUND: Depression may contribute to neurocognitive impairment (NCI) in people with HIV (PWH). Attributing NCI to depression rather than to HIV is complicated as depression may be both a causal factor and an effect of NCI. This study aimed to determine the association between depressive symptoms and NCI among PWH with well-controlled infection. METHODS: The Neurocognitive Assessment in the Metabolic and Ageing Cohort study is an ongoing, prospective, longitudinal study of PWH aged ≥45 years old nested within the Swiss HIV Cohort Study. Neurocognitive Assessment in the Metabolic and Ageing Cohort study participants underwent neurocognitive assessment and grading of depressive symptoms using the Centre for Epidemiological Studies Depression Scale. Neurocognitive impairment categories were defined using Frascati criteria. Participants with NCI related to neurological or psychiatric confounders other than depression were excluded. The cross-sectional association between the Centre for Epidemiological Studies Depression score and neurocognitive impairment was examined taking Centre for Epidemiological Studies Depression score as a continuous variable and then as a binary variable using two score thresholds, 16 and 27. RESULTS: Excluding 79 participants with confounding factors, 902 participants were studied: 81% were men; 96% had plasma viral loads <50 copies/ml; 35% had neurocognitive impairment; 28% had Centre for Epidemiological Studies Depression scores ≥16. Higher Centre for Epidemiological Studies Depression scores were associated with female sex (p = 0.0003), non-Caucasian origin (p = 0.011) and current/past intravenous drug use (p = 0.002). Whilst neurocognitive impairment was associated with higher Centre for Epidemiological Studies Depression scores, the Centre for Epidemiological Studies Depression score was a poor predictor of having neurocognitive impairment (area under the ROC curve 0.604). Applying a Centre for Epidemiological Studies Depression score threshold of 16 predicted the presence of neurocognitive impairment with a sensitivity of 38.3% (specificity 77.2%), increasing the threshold to 27 lowered sensitivity to 15.4% (specificity 93.6%). CONCLUSION: In this large cohort of PWH in Switzerland, we did not observe a Centre for Epidemiological Studies Depression score threshold that was sensitive in predicting neurocognitive impairment. As neurocognitive impairment was however associated with higher Centre for Epidemiological Studies Depression scores, the data support the screening for and treatment of depression among PWH diagnosed with neurocognitive impairment.
BACKGROUND:Depression may contribute to neurocognitive impairment (NCI) in people with HIV (PWH). Attributing NCI to depression rather than to HIV is complicated as depression may be both a causal factor and an effect of NCI. This study aimed to determine the association between depressive symptoms and NCI among PWH with well-controlled infection. METHODS: The Neurocognitive Assessment in the Metabolic and Ageing Cohort study is an ongoing, prospective, longitudinal study of PWH aged ≥45 years old nested within the Swiss HIV Cohort Study. Neurocognitive Assessment in the Metabolic and Ageing Cohort study participants underwent neurocognitive assessment and grading of depressive symptoms using the Centre for Epidemiological Studies Depression Scale. Neurocognitive impairment categories were defined using Frascati criteria. Participants with NCI related to neurological or psychiatric confounders other than depression were excluded. The cross-sectional association between the Centre for Epidemiological Studies Depression score and neurocognitive impairment was examined taking Centre for Epidemiological Studies Depression score as a continuous variable and then as a binary variable using two score thresholds, 16 and 27. RESULTS: Excluding 79 participants with confounding factors, 902 participants were studied: 81% were men; 96% had plasma viral loads <50 copies/ml; 35% had neurocognitive impairment; 28% had Centre for Epidemiological Studies Depression scores ≥16. Higher Centre for Epidemiological Studies Depression scores were associated with female sex (p = 0.0003), non-Caucasian origin (p = 0.011) and current/past intravenous drug use (p = 0.002). Whilst neurocognitive impairment was associated with higher Centre for Epidemiological Studies Depression scores, the Centre for Epidemiological Studies Depression score was a poor predictor of having neurocognitive impairment (area under the ROC curve 0.604). Applying a Centre for Epidemiological Studies Depression score threshold of 16 predicted the presence of neurocognitive impairment with a sensitivity of 38.3% (specificity 77.2%), increasing the threshold to 27 lowered sensitivity to 15.4% (specificity 93.6%). CONCLUSION: In this large cohort of PWH in Switzerland, we did not observe a Centre for Epidemiological Studies Depression score threshold that was sensitive in predicting neurocognitive impairment. As neurocognitive impairment was however associated with higher Centre for Epidemiological Studies Depression scores, the data support the screening for and treatment of depression among PWH diagnosed with neurocognitive impairment.
Authors: Bernadette Jakeman; Alexandra U Scherrer; Katharine E A Darling; Jose Damas; Melanie Bieler-Aeschlimann; Barbara Hasse; Ladina Schlosser; Anna Hachfeld; Klemens Gutbrod; Philip E Tarr; Alexandra Calmy; Frederic Assal; Ursula Kunze; Marcel Stoeckle; Patrick Schmid; Gianina Toller; Stefania Rossi; Caroline di Benedetto; Renaud du Pasquier; Matthias Cavassini; Catia Marzolini Journal: Open Forum Infect Dis Date: 2022-09-02 Impact factor: 4.423