Long-term health outcomes among CNS HAND Study cohort

doi:10.26190/unsworks/24124

Long-term health outcomes among CNS HAND Study cohort

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Abstract

The CNS HAND study was primarily conducted among 254 people living with HIV (PLHIV) and 72 HIV-negative persons from a primary care clinic in Sydney, Australia named Holdsworth House General Practice to assess the burden of HIV-associated neurocognitive disorder (HAND) among PLHIV and to validate the CogState computerized cognitive screening tool for the diagnosis of HAND. This baseline study took place between October 2011 and October 2012. Exclusion criteria at the entry of the study was alcohol or substance intoxication. Providing that majority of the study participants continue receiving care at the clinic, their long-term health outcome data on age-related non-AIDS conditions (major neurological and cognitive disorders, cardiovascular diseases, diabetes, osteoporosis, non-AIDS cancers, and chronic kidney, liver and lung diseases) were collected in June 2021 censoring the study end point at the end of April 2021. Three HIV-negative participants were excluded from this long-term outcome study because of seroconversion during the study follow-up period. This deidentified individual participant dataset was used for survival analyses to identify if PLHIV despite under suppressive combination antiretroviral therapy has higher risks for age-related non-AIDS conditions compared to age and lifestyle-matched HIV-negative persons.

Publication Year

2022-06-22

Resource Type

Dataset

Keyword(s)

HIV
Aging
CVD
Congitive disorder
Diabetes
Osteoporosis
Cancer
Survival analysis

UNSW Faculty

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CNS HAND Study_longterm outcome_UNSWorks.csv	216.7 KB	Comma-Separated Values File
Readme.rtf	2.89 KB	Microsoft Word

Related publication(s)

Cognitive aging in people living with HIV: concept development and empirical evidence from several longitudinal cohorts in Australia and beyond

(2022) Aung, Htein Linn

Thesis

With widespread access to combination anti-retroviral therapy (cART) and HIV suppression, life expectancy among people living with HIV (PLHIV) is increasing more than ever. According to UNAIDS, there were 8.1 million older PLHIV (i.e., 50 years of age and over) in 2020 globally. Although HIV-associated dementia has become rare in the cART era, mild neurocognitive impairments remain prevalent among PLHIV (~30% in virally suppressed). With aging, there is an increasing concern that HIV may precipitate neurocognitive abnormal aging because HIV is associated with increased markers of aging (e.g., immunosenescence and hyper-coagulopathy) and multiple age and HIV-related comorbidities (e.g., cardiovascular diseases). Importantly, these comorbidities occur at an earlier age and at a higher rate among PLHIV compared to age-matched HIV-negative persons. Earlier, more severe and more rapidly progressing neurocognitive impairment would have major public health consequences for the millions of PLHIV and the healthcare system. The overarching aim of this PhD thesis is to determine whether having chronic stable HIV infection and suppressive ART is associated with abnormal cognitive aging including premature cognitive aging (HIV and age synergistically/addictively lead to much lower cognitive performance at a younger age compared to controls), accentuated cognitive aging (HIV and age synergistically/addictively lead to much greater prevalence and severity of neurocognitive impairment), and/or accelerated cognitive aging (HIV and age synergistically/ addictively lead to much more rapid progression of neurocognitive impairment). To address these questions, we used a range of scientific methodologies including a systematic review, and several types of advanced statistical analyses using national and international longitudinal cohort data. First, to contextualise the potential public health consequences of cognitive aging in PLHIV, we conducted a narrative review of the burden of established dementia risk factors among PLHIV. We identified that the burden of several major dementia risk factors is much greater among PLHIV than in the general population. Second, we conducted the first-ever systematic review evaluating the current evidence for premature, accentuated and accelerated cognitive aging among PLHIV. We determined moderate evidence for premature cognitive aging and strong evidence for accelerated cognitive aging, while accentuated cognitive aging had not been optimally assessed. Lastly, addressing the previous literature major limitations (low sample size, cross-sectional study design, low proportion of older PLHIV, and inadequate controls/norms), we quantified the profiles of cognitive aging in four longitudinal studies of PLHIV. We demonstrated robust trends for premature cognitive aging among PLHIV compared to age-matched HIV-negative persons. We also demonstrated that older PLHIV had a higher risk for both neurocognitive impairment and neurocognitive decline compared to younger PLHIV, while controlling for normative age effect. These results are indicative of both accentuated and accelerated aging, although our research identified the need for longer-term studies using very large sample size to assess these trends especially in PLHIV older than 70+. Based on these findings, we discussed implications for clinical practice and future research directions.

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