Declining Prevalence of Human Immunodeficiency Virus (HIV)–Associated Neurocognitive Disorders in Recent Years and Associated Factors in a Large Cohort of Antiretroviral Therapy–Treated Individuals With HIV

• Published in: Clinical infectious diseases 2023-02, Vol.76 (3), p.e629-e637
• Main Authors: Mastrorosa, Ilaria, Pinnetti, Carmela, Brita, Anna Clelia, Mondi, Annalisa, Lorenzini, Patrizia, Del Duca, Giulia, Vergori, Alessandra, Mazzotta, Valentina, Gagliardini, Roberta, Camici, Marta, De Zottis, Federico, Fusto, Marisa, Plazzi, Maria Maddalena, Grilli, Elisabetta, Bellagamba, Rita, Cicalini, Stefania, Antinori, Andrea
• Format: Article
• Language: English
• Subjects: Cross-Sectional Studies; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; Humans; Major; Neurocognitive Disorders - epidemiology; Prevalence
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciac658

Abstract Background HIV-associated neurocognitive disorders (HAND) have been suggested as persistent even with effective antiretroviral therapy (ART). Aims were to evaluate HAND prevalence and associated factors, in a large cohort of people-with-HIV (PWH). Methods ART-treated PWH, underwent a neuropsychological examination through a battery of 12 tests exploring 5 different domains, between 2009 and 2020, were included in this cross-sectional analysis. HAND were classified according to Frascati's criteria. Participants were defined as complaining or not-complaining if a cognitive complaint was reported or not. Chi-square for trend and multivariable logistic regression were fitted. Results Overall, 1424 PWH were enrolled during four three-years periods. HAND prevalence was 24%; among complainers (572/1424), it was 38%, higher than among not-complainers (15%). Over the study period, a decreasing HAND prevalence was found in the entire population (P < 0.001) and in complaining (P < 0.001); in not-complaining it remained stable (P = 0.182). Factors associated with HAND were older age, lower educational level, lower current CD4+ T-cell count and HCV co-infection. Compared to nonnucleoside reverse transcriptase inhibitors, receiving dual and integrase strand transfer inhibitor (INSTI)-based therapies was associated with a decreased risk of HAND, as well as being tested in more recent years. Conclusions In this large cohort of ART-treated PWH, mostly virologically suppressed, a remarkable decreasing HAND prevalence was observed. Besides HIV- and patient-related factors, the reduced risk of HAND found with dual and INSTI-based regimens along with a more recent ART initiation, could suggest a potential role of new treatment strategies in this decline, due to their greater virologic efficacy and better tolerability. Over the last decade, a decreasing prevalence of human immunodeficiency virus (HIV)–associated neurocognitive disorders (HAND) was found. The asymptomatic form remained prevalent compared with symptomatic stages. A reduced risk for HAND was observed with dual and integrase strand transfer inhibitor–based regimens, along with more recent initiation of antiretroviral therapy.