Abstract Body

HIV-associated cognitive impairment (CI) remains relevant in people living with HIV (PLWH) treated with antiretroviral therapy. However, risk factors for CI may differ in populations of PLWH of different ethnicity. We compared the prevalence and determinants of CI in a Northern European and a Korean cohort of PLWH, and assessed the ability of individual cognitive tests to discriminate between those with and without CI.

Cognitive performances were assessed using a comparable battery covering 6 domains in 134 PLWH aged ≥45 years in the EU-funded COBRA study (Netherlands, UK), and 194 PLWH aged ≥18 years from the NeuroAIDS Project (Korea). Cognitive scores were standardized using population-specific normative scores and averaged into an overall score. Determinants of cognitive function were evaluated using linear regression. Factors that were associated with cognitive function in univariate analyses were selected for inclusion in a multivariable model. The discriminative ability of individual cognitive tests to detect CI, as defined by an overall score ≤0.5 standard deviations (SD) below the mean, was assessed using the area under the receiver operating characteristic curve (AUROC).

The 134 COBRA PLWH (mean age: 57 yrs, 93% male, 88% white ethnicity, 100% on cART) had a higher CD4 (mean (SD): 646 (214) cells/µL) and lower rate of anaemia (8.3% with haemoglobin ≤13 g/dL) compared to the 194 Korean PLWH (45 yrs, 94% male, 90% on cART, mean (SD) CD4: 481 (236) cells/µL, 19.1% with anaemia). The prevalence of CI was 18.8% in COBRA PLWH and 18.0% in Korean PLWH (p=0.86). In COBRA, being of African descent was the main determinant of cognitive function (p<0.01) whereas in the Korean cohort anaemia (other than years of education) was the main risk factor (p=0.1, Table). The discriminative ability of CI screening was highest for tests of attention (AUROC of 0.81 to 0.84) and executive function (0.80-0.88) in COBRA PLWH and for tests of processing speed (0.73-0.80) and motor skills (AUROC=0.78) in Korean PLWH.

Two cohorts of PLWH from different geographic regions show similar CI rates when assessed using similar cognitive tests. However, determinants of cognitive performance in the two cohorts differ considerably with ethnicity and anaemia being important determinants in one but not the other cohort. These findings suggest that differences in ethnicity and other diseases should be taken into consideration when comparing CI rates in different geographic regions.