Background
There is accumulating evidence that SARS-CoV-2 infection may have lasting effects on cognition in a subset of individuals. However, there is scarce data on the impact of COVID-19 on cognitive performance in people with HIV (PWH), who may experience cognitive impairment despite viral suppression by antiretroviral therapy (ART). We examined the trajectory of cognitive parameters 1 year pre- and post-COVID-19 in PWH on stable ART initiated during acute HIV infection (AHI).
Methods
RV254 participants are enrolled during AHI (Fiebig I-V), initiated ART within days, and longitudinally followed with a 4-test cognitive battery that evaluated executive function (Color Trails 1 & 2, CT1 & CT2), processing speed (Trail Making A, TMA), and fine motor speed/dexterity (non-dominant hand Grooved Pegboard, GPB). Raw scores were standardized and averaged to determine an overall performance (NPZ-4) score. In participants on ≥ 48 weeks of stable ART with documented COVID-19, cognitive test z-scores 1 year pre- and post-COVID-19 were regressed on time using linear mixed models. Time in years since COVID-19 diagnosis was entered as a linear spline with knots at the time of COVID-19 diagnosis and 0.25-year intervals thereafter; each time point after diagnosis was compared with the value at diagnosis.
Results
Between April 2021 and September 2022, 269 participants on ≥ 48 weeks of stable ART (97% males, median age 32 [interquartile range 29-37]) were diagnosed with COVID-19. Of these, 221 (82%) were diagnosed with COVID-19 during the Omicron wave; 229 (85%) received ≥2 doses of COVID-19 vaccines prior to diagnosis; 4 (1.5%) required supplemental oxygen, 1 required intensive care, and there were no fatalities. Compared with values at the time of COVID-19 diagnosis, there were significant declines in the TMA z-score at 3 months (0.90 vs 0.55, p=0.02) and the NPZ-4 score at 6 months (1.02 vs. 0.89, p=0.03) after diagnosis (Figure 1). CT1, CT2, and GPB z-scores remained stable over this period.
Conclusions
In this cohort of young, mostly male PWH with HIV suppression after early ART, we observed modest but significant changes in processing speed and overall neurocognitive performance up to 6 months after acute COVID-19. Longer follow-up and monitoring of post-acute cognitive sequelae of SARS-CoV-2 infection together with longitudinal assessments of soluble immune markers in cerebrospinal fluid and brain MRI are ongoing to determine the long-term impact of COVID-19 on cognitive outcomes in PWH.
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