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Clin Infect Dis. 2019 Sep 3. pii: ciz868. doi: 10.1093/cid/ciz868. [Epub ahead of print]

Self-reported neurocognitive impairment in people living with HIV: Characterizing clusters of patients with similar changes in self-reported neurocognitive impairment 2013-2017 in the Swiss HIV Cohort Study.

Author information

1
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
2
Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
3
Clinic for Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
4
University Department of Medicine, Kantonsspital Baselland, University of Basel, Basel, Switzerland.
5
Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.
6
Department of Infectious Diseases, HIV unit, Geneva University Hospital, University of Geneva, Geneva, Switzerland.
7
Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland.
8
Division of Infectious Diseases, Cantonal Hospital St Gallen, St. Gallen, Switzerland.
9
Department of Clinical Neurosciences, Service of Neurology, Neuroimmunology Unit, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.

Abstract

INTRODUCTION:

Self-reported neurocognitive impairment (srni) in people living with human immunodeficiency virus-1 (HIV-1) infection are frequent. We use longitudinal information on srni in the Swiss HIV Cohort Study (SHCS) to identify and characterize groups of patients with persisting srni over time.

METHODS:

We included all SHCS patients who were assessed for srni during at least 5 visits spanning at least 2.5 years in 2013-2017. We first compared patients with srni to those without srni over the whole study period. Second, we used a hierarchical cluster algorithm to identify groups of patients with similar changes of srni over time. In both analyses, we studied clinical and demographic factors potentially influencing srni.

RESULTS:

In total, 79'683 questionnaires of 11'029 patients contained information about srni, and 8'545/11'029 (77.5%) patients had longitudinal information. The overall percentage of patients with srni decreased from 19.6% in 2013 to 10.7% in 2017. Compared to patients in the cluster with low-level srni over time, patients in the cluster with high-level persisting srni had more often a prior opportunistic infection of the central nervous system (CNS) (OR=3.7, p<0.001), imperfect adherence to antiretroviral treatment (ART) (OR=2.8, p<0.001) and a depression (OR=1.9, p<0.001).

CONCLUSIONS:

Although overall srni is decreasing in the SHCS, there is a group of patients with persisting srni over time. Past opportunistic infections of the CNS, imperfect adherence to ART as well as depression were associated most with persisting srni. Patients with these characteristics should be preferentially tested for neurocognitive impairment.

KEYWORDS:

HIV; self-reported neurocognitive impairment

PMID:
31504323
DOI:
10.1093/cid/ciz868

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