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Santos G, Locatelli I, Métral M, Berney A, Nadin I, Calmy A, Tarr P, Gutbrod K, Hauser C, Brugger P, Kovari H, Kunze U, Stoeckle M, Früh S, Schmid P, Rossi S, Di Benedetto C, Du Pasquier R, Darling K, Cavassini M. The association between depressive symptoms and neurocognitive impairment in people with well-treated HIV in Switzerland. Int J STD AIDS 2021; 32:729-739. [PMID: 33629882 DOI: 10.1177/0956462420987434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depression may contribute to neurocognitive impairment (NCI) in people with HIV (PWH). Attributing NCI to depression rather than to HIV is complicated as depression may be both a causal factor and an effect of NCI. This study aimed to determine the association between depressive symptoms and NCI among PWH with well-controlled infection. METHODS The Neurocognitive Assessment in the Metabolic and Ageing Cohort study is an ongoing, prospective, longitudinal study of PWH aged ≥45 years old nested within the Swiss HIV Cohort Study. Neurocognitive Assessment in the Metabolic and Ageing Cohort study participants underwent neurocognitive assessment and grading of depressive symptoms using the Centre for Epidemiological Studies Depression Scale. Neurocognitive impairment categories were defined using Frascati criteria. Participants with NCI related to neurological or psychiatric confounders other than depression were excluded. The cross-sectional association between the Centre for Epidemiological Studies Depression score and neurocognitive impairment was examined taking Centre for Epidemiological Studies Depression score as a continuous variable and then as a binary variable using two score thresholds, 16 and 27. RESULTS Excluding 79 participants with confounding factors, 902 participants were studied: 81% were men; 96% had plasma viral loads <50 copies/ml; 35% had neurocognitive impairment; 28% had Centre for Epidemiological Studies Depression scores ≥16. Higher Centre for Epidemiological Studies Depression scores were associated with female sex (p = 0.0003), non-Caucasian origin (p = 0.011) and current/past intravenous drug use (p = 0.002). Whilst neurocognitive impairment was associated with higher Centre for Epidemiological Studies Depression scores, the Centre for Epidemiological Studies Depression score was a poor predictor of having neurocognitive impairment (area under the ROC curve 0.604). Applying a Centre for Epidemiological Studies Depression score threshold of 16 predicted the presence of neurocognitive impairment with a sensitivity of 38.3% (specificity 77.2%), increasing the threshold to 27 lowered sensitivity to 15.4% (specificity 93.6%). CONCLUSION In this large cohort of PWH in Switzerland, we did not observe a Centre for Epidemiological Studies Depression score threshold that was sensitive in predicting neurocognitive impairment. As neurocognitive impairment was however associated with higher Centre for Epidemiological Studies Depression scores, the data support the screening for and treatment of depression among PWH diagnosed with neurocognitive impairment.
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Affiliation(s)
- Galia Santos
- Infectious Diseases Service, 30635Lausanne University Hospital, Lausanne, Switzerland
| | - Isabella Locatelli
- Division of biostatistics and quantitative methods, Institute of Social and Preventive Medicine, 30640Lausanne University Hospital, Lausanne, Switzerland
| | - Mélanie Métral
- Laboratory of neuroimmunology, Research Centre of clinical neurosciences, Department of clinical neurosciences, 419233Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandre Berney
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Isaure Nadin
- Laboratory of neuroimmunology, Research Centre of clinical neurosciences, Department of clinical neurosciences, 419233Lausanne University Hospital, Lausanne, Switzerland.,Department of Neurology, 27230Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Alexandra Calmy
- HIV unit, Infectious Diseases Division, Medicine Specialties Department, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Philip Tarr
- University Department of Medicine, Kantonsspital Bruderholz, 27209University of Basel, Bruderholz, Basel, Switzerland
| | - Klemens Gutbrod
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital Bern, Bern, Switzerland
| | - Christoph Hauser
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Brugger
- Department of Neuropsychology, Neurology Clinic, 27243University Hospital Zürich, Zürich, Switzerland
| | - Helen Kovari
- Department of Infectious Diseases and Hospital Epidemiology, Universitätsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Ursi Kunze
- Memory Clinic, University Centre for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, 30262University Hospital Basel, University of Basel, Basel, Switzerland
| | - Severin Früh
- Department of Neurology, Neuropsychology Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Schmid
- Infectious Diseases and Hospital Epidemiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stefania Rossi
- Neuropsychology Unit, 30721Lugano Regional Hospital, Lugano, Switzerland
| | | | - Renaud Du Pasquier
- Service of Neurology, Department of clinical neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Katharine Darling
- Infectious Diseases Service, 30635Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, 30635Lausanne University Hospital, Lausanne, Switzerland
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