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.