Reduced HAND prevalence in large cross-sectional cohort study
3 October 2022. Related: Coinfections and complications.
A study evaluated the prevalence of HAND (HIV-associated neurocognitive disorders) in a large cross-sectional cohort (n=1424). HAND prevalence decreased from 39% to 18% across a 12-year period from 2009 to 2020.
Lower prevalence of HAND was associated with INSTI-containing regimens, being HCV negative, younger age and CD4 count <350 cells/mm3. Whilst complainers experienced a higher rate (38%) of HAND, 15% of those that were non-complainers also met HAND criteria.
HAND prevalence was assessed in HIV positive participants (n=1,424) in a retrospective observational cross-sectional cohort study. Each participant had undergone at least one neuropsychological assessment (NPA) as indicated for clinical (e.g. suspected or increased risk of neurocognitive impairment (NCI)) or research purposes. This study reported the outcomes for the first NPA only. Results are presented for NPAs conducted between 2009 to 2011 (n=244), 2012 to 2014 (n=414), 2015 to 2017 (n=292) or 2018 to 2020 (n=474).
NCI was assessed using the three-question screening test to assess memory, reasoning, and attention, as recommended by EACS guidelines. Participants with positive screening tests were classified as “complaining” and those that were negative were “not-complaining”. NCI included a comprehensive array of 12 tests to explore 5 areas of cognition and HAND was classified using Frascati’s criteria (HIV-associated dementia (HAD), mild or asymptomatic).
HAND prevalence was 24% (n=327) across the study population, which was split between asymptomatic (17%), mild (6%) and HAD (1%). When considering complainers and non-complainers, HAND prevalence as 38% and 15%, respectively.
Over time HAND prevalence decreased from 39% for the earliest group (2009 to 2011) to 18% for the most recent group (2018 to 2020) p>0.001. Rates declined for both groups but was only significant for complainers. The proportion of asymptomatic diagnoses remained stable, whilst mild diagnoses declined over time. HAD prevalence did not change over time.
Potential HAND risk factors were calculated from pooled data from complainers and non-complainers. Increasing age by 10 years (AOR: 1.01, 95%CI: 1.00 to 1.18) and being HCV positive (AOR: 1.37, 95%CI: 1.02 to 1.85) increased the chance of HAND. CD4 counts >350 cells/mm3 were associated with lower risk of HAND (AOR: 0.66, 95%CI: 0.46 to 0.95). Reduced incidence of HAND was detected for INSTI-containing ART (AOR: 0.65, 95% CI: 0.47 to 0.99) and dual therapy (AOR: 0.54, 95% CI: 0.34 to 0.87), relative to NNRTI-containing regimens. It is not clear whether reduced HAND incidence on INSTI-containing regimens is due to positive effect of the drug or better virologic control in these people.
Participants were HIV positive, predominantly men (81%) with a median age of 49 years (IQR: 41 to 55). 19% of participants had viral load >50 copies/mL. Median CD4 counts were lower for those in the complaining group (512 cells/mm3, IQR: 297 to 526) compared to the non-complaining group (605 cells/mm3, IQR: 433 to 790). The most used ART regimen was NRTI+NNRTI (41%), followed by NRTI+PI (21%), NRTI+INSTI (16%) and dual therapy (9%). There were significantly more people on BIC in the complaining group (n=135) compared to the non-complaining group (n=10), p<0.001.
References
Mastrorosa I et al. Declining prevalence of HIV-associated neurocognitive disorders in more recent years and associated factors, in a large cohort of ART-treated HIV-infected individuals. Clinical Infectious Diseases, ciac658. (19 August 2022).