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J Acquir Immune Defic Syndr. 2018 Sep 1;79(1):83-91. doi: 10.1097/QAI.0000000000001755.

Cognitive Burden of Common Non-antiretroviral Medications in HIV-Infected Women.

Author information

1
Department of Psychiatry, University of Illinois at Chicago, Chicago, IL.
2
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
3
Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA.
4
Departments of Experimental and Clinical Pharmacology and Psychiatry, University of Minnesota, Minneapolis, MN.
5
Department of Epidemiology and Biostatistics, School of Public Health, Univeristy of Illinois at Chicago, Chicago, IL.
6
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
7
Department of Psychology, University of Illinois at Chicago, Chicago, IL.
8
Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
9
Department of Family Medicine, Georgetown University Medical Center, Washington, DC.
10
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
11
Cook County Health & Hospital System, Hektoen Institute of Medicine, Chicago, IL.
12
Department of Neurology, SUNY-Downstate Medical Center, Brooklyn, NY.

Abstract

OBJECTIVE:

The aging HIV population has increased comorbidity burden and consequently non-antiretroviral medication utilization. Many non-antiretroviral medications have known neurocognitive-adverse effects ("NC-AE medications"). We assessed the cognitive effects of NC-AE medications in HIV+ and HIV- women.

METHODS:

One thousand five hundred fifty-eight participants (1037 HIV+; mean age 46) from the Women's Interagency HIV Study completed a neuropsychological test battery between 2009 and 2011. The total number of NC-AE medications and subgroups (eg, anticholinergics) were calculated based on self-report. Generalized linear models for non-normal data were used to examine the cognitive burden of medications and factors that exacerbate these effects.

RESULTS:

HIV+ women reported taking more NC-AE medications vs. HIV- women (P < 0.05). NC-AE medication use altogether was not associated with cognitive performance. However, among NC-AE medication subgroups, anticholinergic-acting medications, but not opioids or anxiolytics/anticonvulsants, were negatively associated with performance. HIV status moderated the association between these NC-AE medication subgroups and performance (P's < 0.05). HIV-serostatus differences (HIV- < HIV+) in global, learning, fluency, and motor function were greatest among women taking >1 anticholinergic medications. HIV-serostatus differences in performance on learning and psychomotor speed were also greatest among women taking 1 or more anxiolytics/anticonvulsants and 1 or more opioids, respectively.

CONCLUSIONS:

HIV+ women have increased cognitive vulnerabilities to anticholinergic, anxiolytic/anticonvulsant, and opioid medications. Potential synergy between these medications and HIV may explain some HIV-related cognitive impairments. It may be important clinically to consider these specific types of medications as a contributor to impaired cognitive performance in HIV+ women and assess the cost/benefit of treatment dosage for underlying conditions.

PMID:
29781879
PMCID:
PMC6092212
[Available on 2019-09-01]
DOI:
10.1097/QAI.0000000000001755

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