Psychosocial risk factors and cognitive decline in people living with HIV: results from the Malaysian HIV and aging (MHIVA) study

HIV Stigma is Associated with Two-Year Decline in Cognitive Performance Among People with HIV

HIV stigma is associated with suboptimal clinical outcomes and has been cross-sectionally linked to cognitive deficits in people with HIV (PWH). However, it is unclear whether HIV stigma precedes cognitive decline or vice versa. We examined associations in 303 adult PWH (mean age 50.01 (11.91) years; 46% female; 67% non-Hispanic Black) between the abbreviated Berger Stigma Scale score and longitudinal change across the NIH Toolbox Cognition Battery measures. 89% of participants reported experiencing HIV stigma. In unadjusted analyses, greater HIV stigma was associated with worse attention performance at yearly follow-up visits (B = -0.07, 95% CI = -0.13 - -0.01, p = 0.025). When adjusting for clinicodemographic variables, HIV stigma was associated with worse processing speed and global cognition at yearly follow-up visits. This finding suggests that HIV stigma precedes subsequent cognitive decline and highlights the importance of reducing stigma to improve cognitive functioning among PWH.

Health Outcomes Associated with Loneliness and Social Isolation in Older Adults Living with HIV: A Systematic Review

Self-management of HIV is crucial to reduce disease-related negative health outcomes. Loneliness and social isolation are associated with poor disease self-management (e.g., medication non-adherence and care disengagement) in younger people with HIV and negative health outcomes in the general older adult population. Older adults with HIV (OWH) are at increased risk for loneliness and social isolation, but the associated health outcomes remain unclear. A comprehensive review of Pubmed, Embase, PsycINFO, and Web of Science databases was conducted. Criteria for inclusion were original quantitative research, published in the English language, included adults with a mean age ≥ 50 years, and included a measure for loneliness or social isolation, and a health outcome measure. A total of 41 studies were analyzed and 19,282 participants contributed to this review. The main findings were that loneliness and social isolation were associated with negative health behavior, disease self-management, physiological, and psychological outcomes. Pooled prevalence of loneliness was 33.9% across 8 studies. Loneliness and social isolation are highly prevalent in OWH and are associated with negative outcomes in OWH, similarly to older adults in the general population. Older adults with HIV, however, are challenged by unique psychosocial circumstances that place them at greater risk for loneliness and social isolation and associated negative health outcomes. These findings should be verified in larger, diverse, and longitudinal samples to better understand interrelationships of psychosocial factors and clinical outcomes in OWH.

Recent advances in HIV-associated neurocognitive disorders: a focus on older adults and sub-Saharan Africa

PURPOSE OF REVIEW

We reviewed recent literature on prevalence and interventional approaches for cognitive impairment in the context of HIV infection alongside current controversies and challenges around its nomenclature, screening, and diagnosis.

RECENT FINDINGS

Prevalence estimates for HIV-associated neurocognitive disorder (HAND) indicate that HAND remains highly prevalent despite combination antiretroviral treatment (cART) widely used. The available data are heterogeneous, particularly in sub-Saharan Africa (SSA) where recent reviews indicate substantial heterogeneity, wide prevalence estimates and lack of data from the majority SSA countries, despite them currently experiencing the greatest burden worldwide of both HIV and HAND.Several alternative approaches to diagnosis and classification of cognitive impairment in HIV have been published, taking into account changing clinical phenotypes.

SUMMARY

Cognitive impairment remains a significant challenge in the care of people living with HIV despite advances in treatment. Ongoing controversies exist around nomenclature and classification, screening measures, and the phenotype and aetiology of observed impairments. Two current areas of research priority and focus include understanding current phenotypes of individuals living and ageing with treated HIV and differing levels of risk for HAND in these phenotypes, alongside the effects of commonly occurring comorbidities.The current evidence base for interventional approaches is limited, but growing. The most promising avenues appear to be multidisciplinary. These are currently focussed on high income settings rather than SSA where the majority of people living with HIV, and affected by cognitive impairment in the context of HIV, currently reside.

Examining biopsychosocial predictors of risk for cognitive impairment among a racially diverse sample of men who have sex with men living with HIV

Background

Cognitive decline among people living with HIV (PLWH) is growing concern as world populations become increasing older including higher proportions of PLWH. It is vitally important to understand psychosocial predictors of age-related cognitive decline men who have sex with men (MSM) living with HIV.

Objectives

The current study seeks to examine psychosocial risk factors the contribute to the risk of age-related cognitive impairment as measured by Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score in a racially diverse sample of MSM living with HIV.

Design

The present analysis utilizes data from the baseline (n = 196) and 6-month follow-up (n = 135) time points of a longitudinal cohort study of PLWH.

Methods

Using a self-report survey, we examine the associations between psychosocial predictors (e.g. trauma, mental health, chronic pain, sleep disturbance, etc.) and risk of dementia using the CAIDE risk score. Analyses include linear and logistic regression.

Results

In adjusted model stress, chronic pain, Black racial identity, and having a sexual identity that is bisexual or another category are all positively associated with CAIDE scores. Childhood sexual abuse history was negatively associated with CAIDE scores indicating a protective effect. Sleep disorder has a positive association with CAIDE scores after adjusting for the baseline CAIDE scores.

Conclusion

These results indicate modifiable correlates of cognitive risk (stress and chronic pain). Interventions should seek to address these comorbid factors including the consideration of minority stress and stigma. Interventions should seek to reach Black and bisexual men living with HIV, including possible cultural tailoring to interventions and messaging. Lastly, future research should examine the impact of variation within childhood sexual abuse histories to better understand their association with cognitive impairment later in life. This may include considering the nature, severity, and potential treatment of trauma symptoms.