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COGNITIVE TRAJECTORIES OVER 4 YEARS AMONG HIV+ WOMEN WITH OPTIMAL VIRAL SUPPRESSION
Leah H. Rubin1, Gayle Springer2, Pauline M. Maki1, Kathryn Anastos3, Deborah Gustafson4, Maria Villacres5, Drenna Waldrop-Valverde6, David Vance7, Hector Bolivar8, Victor Valcour9
1Univ of Illinois at Chicago, Chicago, IL, USA,2The Johns Hopkins Univ, Baltimore, MD, USA,3Albert Einstein Coll of Med, Bronx, NY, USA,4SUNY Downstate Med Cntr, Brooklyn, NY, USA,5Univ of Southern California, Los Angeles, CA, USA,6Emory Univ, Atlanta, GA, USA,7Univ of Alabama at Birmingham, Birmingham, AL, USA,8Univ of Miami, Miami, FL, USA,9Univ of California San Francisco, San Francisco, USA
An estimated 50% of HIV-infected individuals will exhibit cognitive impairment during their lifetime despite benefits of combination antiretroviral therapy (cART). Although rates of impairment are lower among virally suppressed HIV-infected (HIV+VS) individuals, impairment still persists even among this subgroup. Little is known about cognitive trajectories among HIV+VS individuals which is needed to provide a framework for understanding mechanisms of detrimental change. Thus, we compared the cognitive trajectories between HIV+VS, HIV-uninfected (HIV-), and HIV+ women without systematic viral control (HIV+NVS). We expected that HIV+VS+ women would perform worse than HIV- women but better than HIV+NVS women on global neuropsychological (NP) test performance, learning, memory, and attention.
From 2009-2016, 1757 Women's Interagency HIV Study participants underwent neurocognitive testing at baseline and biennially for 4 years (max 3 testing sessions/person). Of 1757 women, there were 661 HIV+VS, 611 demographically-similar HIV-, and 485 HIV+NVS women. VS was defined as consistent HIV RNA in plasma <500ml/cp and cART use across all sessions. Mixed effects regressions were used to examine group differences and group x time interactions on cognition controlling for relevant demographic, behavioral, and clinical factors.
The cohort was 61% non-Hispanic Black, middle-aged (mean=46yrs, SD=9), and 54% had high school or less education. HIV+VS women demonstrated lower scores on global NP performance, memory, attention, executive function, and speed versus HIV- women (p's<0.05; Figure 1). HIV+NVS women showed lower scores versus HIV+VS women on global NP performance, memory, learning, and motor skills (p's<0.05). HIV- women showed improved motor skills whereas HIV+VS women did not improve (p<0.01). HIV+NVS women did not demonstrate global NP performance gains as those seen among HIV+VS women (p<0.05). HIV+NVS women showed less improvement on motor skills and executive function as compared to the HIV- women (p's<0.05).
Cognitive difficulties remain present even among women with consistent viral suppression. While there are some differences in trajectories between groups, cognitive difficulties persist in HIV+VS women over time. Findings reinforce a need to identify mechanisms bypassing the direct and indirect effects of the virus on the CNS and the importance of developing novel therapies to attenuate cognitive problems.