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. Clinical Infectious Diseases
Kusejko et al. aimed to study potential factors known to influence neurocognitive performance among people living with HIV. The author team included all SHCS patients who were assessed for self-reported neurocognitive impairment (srni) during at least 5 visits spanning at least 2.5 years in 2013-2017. Hierarchical cluster algorithm was used to identify groups of patients with similar changes of srni over time.
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 (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).
In summary, the study-findings show that srni significantly decreased in 2013-2017, which most likely can be attributed to more potent and earlier initiation of therapies used in recent years and decreasing treatment failures in the SHCS. Furthermore, the study-results suggest that all patients with a history of central nervous system opportunistic infections should be screened in-depth for neurocognitive problems, even if the opportunistic infection occurred a long time ago and the patient has been on suppressive ART for many years. In addition, patients reporting imperfect adherence to ART or having a depression should be considered for further screening of neurocognitive problems. Selecting patients for in-depth neurocognitive screening based on these three criteria is in particular useful for cohorts and patients without longitudinal information about srni.