Aging, neurocognitive impairment and adherence to antiretroviral therapy in human immunodeficiency virus-infected individuals

Pinheiro, Cézar Arthur Tavares; Souza, Luciano Dias de Mattos; Motta, Janaína Vieira dos Santos; Kelbert, Evelin Franco; Martins, Clarissa de Souza Ribeiro; Souza, Marília Silva de; Pinheiro, Karen Amaral Tavares; Coelho, Fábio Monteiro da Cunha; Pinheiro, Ricardo Tavares

doi:10.1016/j.bjid.2016.09.006

Cited by 16 publications

(14 citation statements)

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“…Additionally, in a prospective study of 146 PLWH with normal neurocognitive function at baseline, PLWH were nearly five times as likely to have a neurocognitive disorder after 14 months follow-up than patients without HIV; however, a logistic regression analysis found no effect of age (≤ 40 or ≥ 50 years) among PLWH on incident neurocognitive disorders over the same follow-up period ( P = 0.410) [ 44 ]. In contrast, in a cross-sectional study ( n = 392), older PLWH were at a higher risk of exhibiting cognitive impairment compared with younger PLWH (OR = 2.28; 95% CI 1.35–3.82; P = 0.002), although the extent to which the cognitive impairment is attributable solely to HIV or to an interaction between HIV infection and other age-related diseases is not fully understood [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

A Review of Long-Term Toxicity of Antiretroviral Treatment Regimens and Implications for an Aging Population

et al. 2018

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Human immunodeficiency virus (HIV) is a chronic infectious disease currently requiring lifelong antiretroviral therapy (ART). People living with HIV (PLWH) face an increased risk of comorbidities associated with aging, chronic HIV, and the toxicity arising from long-term ART. A literature review was conducted to identify the most recent evidence documenting toxicities associated with long-term ART, particularly among aging PLWH. In general, PLWH are at a greater risk of developing fractures, osteoporosis, renal and metabolic disorders, central nervous system disorders, cardiovascular disease, and liver disease. There remains limited evidence describing the economic burden of long-term ART. Overall, an aging HIV population treated with long-term ART presents a scenario in which the clinical, humanistic, and economic burden for healthcare systems will demand thoughtful policy solutions that preserve access to treatment. Newer treatment regimens with fewer drugs may mitigate some of the cumulative toxicity burden of long-term ART.Funding: ViiV Healthcare.Electronic supplementary materialThe online version of this article (10.1007/s40121-018-0201-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

A Review of Long-Term Toxicity of Antiretroviral Treatment Regimens and Implications for an Aging Population

et al. 2018

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“…24,25 Brazilian studies have ratified this type of association among HIV-positive individuals of younger age. 13,15 Adults living with HIV can expect to gain many benefits from aerobic exercise, with improved cardiorespiratory function and psychological health. 26 Thus, the association between practicing exercise and adherence to therapy may be related to a possible improvement of psychological health, thereby leading to self-care.…”

Section: Resultsmentioning

confidence: 99%

“…Pinheiro et al 13 found that elderly patients had a higher adherence rate and, consequently, that a higher proportion of these patients had an undetectable viral load. Additionally, nonadherence has been correlated with use of illicit drugs, 14,15 smoking, 14,16 alcohol consumption, 16 depressive symptoms, 17 lower schooling levels and economic status, 8,15 adverse reactions, 18 symptoms of opportunistic diseases 8 and longer time between infection and receiving the diagnosis of HIV and starting treatment.…”

Section: Introductionmentioning

confidence: 99%

Adherence to antiretroviral therapy among people living with HIV/AIDS in northeastern Brazil: a cross-sectional study

et al. 2019

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BACKGROUND: Nonadherence to antiretroviral therapy (ART) may lead to viral replication and development of antiretroviral resistance. OBJECTIVE: To identify the factors associated with nonadherence to ART among people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). DESIGN AND SETTING: Cross-sectional study in a tertiary-level hospital in northeastern Brazil. METHODS: Intake of less than 90% of the antiretroviral drugs prescribed in the last week prior to the interview was defined as nonadherence. Intake was evaluated using a questionnaire. Descriptive and multivariate analyses were conducted on the study population, with estimation of the respective odds ratios and 95% confidence intervals. RESULTS: The prevalence of nonadherence was 28.4%. Significant associations were found regarding the following variables: age less than 35 years, smoking, sedentary lifestyle, lack of medication and lack of knowledge regarding the patient's HIV status, on the part of the patient's partner or family. CONCLUSIONS: Encouragement of adherence to antiretroviral therapy is one of the fundamental pillars of treatment for HIV-infected patients. The high proportion of nonadherence (28.4%) and the predictive factors related to this indicate that it is necessary to improve patients' adherence to antiretroviral therapy.

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“…The majority of the studies were conducted in the US while two studies originated from the UK [29,30], Italy [31,32], China [33,34], and Poland [35,36], and one was carried out in Japan [37], Brazil [38], and Australia [39]. No study was conducted in low-income countries.…”

Section: Locations and Age Of Studiesmentioning

confidence: 99%

“…All of the studies used comprehensive neuropsychological tests to measure neurocognitive performance, and three studies used screening tests like the International HIV Dementia Scale (IHDS) and Montreal Cognitive Assessment (MoCA) [33,34,38]. Only six [32,35,42,50,54,59] out of 22 studies with HIV-controls and nine [31,37,48,49,56,[61][62][63][64] out of 15 studies without a control group standardized cognitive test scores with normative data.…”

Section: How Was the Cognition Measured And Defined?mentioning

confidence: 99%

Is There Any Evidence of Premature, Accentuated and Accelerated Aging Effects on Neurocognition in People Living with HIV? A Systematic Review

et al. 2020

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Despite evidence of premature, accentuated and accelerated aging for some age-related conditions such as cardiovascular diseases in people living with HIV (PLHIV), the evidence for these abnormal patterns of aging on neurocognition remains unclear. Further, no systematic review has been dedicated to this issue. Using PRISMA guidelines, we searched standard databases (PubMed, EMBASE, CINAHL and PsycINFO). Articles were included if they analyzed and reported the effect of age on neurocognition among PLHIV as one of their major findings, if they were conducted in the combination anti-retroviral therapy era (after 1996) and published in a peer-reviewed journal in English. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) appraisal tools. To systematically target the abnormal patterns of neurocognitive aging, we define premature cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive test performance covering both the normal and abnormal performance range; accentuated cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive impairment (NCI) rate, thus covering the abnormal performance range only; accelerated cognitive aging as significant interaction effect of HIV status and age on longitudinal neurocognitive test performance or incidence of NCI. Because these definitions require an age-comparable HIV-negative (HIV−) control group, when no controls were included, we determined the range of the age effect on neurocognitive test performance or NCI among PLHIV. A total of 37 studies originating from the US (26), UK (2), Italy (2), Poland (2), China (2), Japan (1), Australia (1), and Brazil (1) were included. Six studies were longitudinal and 14 included HIV- controls. The quality appraisal showed that 12/37 studies neither used an age-matched HIV- controls nor used demographically corrected cognitive scores. A meta-analysis was not possible because study methods and choice of neurocognitive measurement methods and outcomes were heterogeneous imposing a narrative synthesis. In studies with an HIV- control sample, premature neurocognitive aging was found in 45% of the cross-sectional analyses (9/20), while accelerated neurocognitive aging was found in 75% of the longitudinal analyses (3/4). There was no evidence for accentuated aging, but this was tested only in two studies. In studies without an HIV- control sample, the age effect was always present but wide (NCI OR = 1.18–4.8). While large sample size (> 500) was associated with abnormal patterns of cognitive aging, most of the studies were under powered. Other study characteristics such as longitudinal study design and higher proportion of older participants were also associated with the findings of abnormal cognitive aging. There is some support for premature and accelerated cognitive aging among PLHIV in the existing literature especially among large and longitudinal studies and those with higher proportion of older samples. Future HIV and cognitive aging studies need to harmonize neuropsychological measurement methods and outcomes and use a large sample from collaborative multi-sites to generate more robust evidences.

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Aging, neurocognitive impairment and adherence to antiretroviral therapy in human immunodeficiency virus-infected individuals

Cited by 16 publications

References 50 publications

A Review of Long-Term Toxicity of Antiretroviral Treatment Regimens and Implications for an Aging Population

A Review of Long-Term Toxicity of Antiretroviral Treatment Regimens and Implications for an Aging Population

Adherence to antiretroviral therapy among people living with HIV/AIDS in northeastern Brazil: a cross-sectional study

Is There Any Evidence of Premature, Accentuated and Accelerated Aging Effects on Neurocognition in People Living with HIV? A Systematic Review

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