Identifying and distinguishing cognitive profiles among virally suppressed people with HIV.

Abstract

Objective: Cognitive deficits are common among people with HIV (PWH), even when virally suppressed. We identified cognitive profiles among virally suppressed PWH and determined how sociodemographic, clinical/ behavioral, and HIV disease characteristics distinguish profile membership. Method: Participants included 704 virally suppressed PWH (M age = 43.9 [SD = 10.2], 88% male, 58.9% non-Hispanic White) from the HIV Neurobehavioral Research Program. Demographically adjusted T scores were derived from a neuropsychological evaluation comprised of 13 tests. We implemented a pipeline involving dimension reduction and clustering to identify profiles of cognitive performance. Random forest models on a 70/30 training/testing set with internal cross-validation were used to identify sociodemographic, clinical/behavioral, and HIV disease correlates of profile membership. Results: Six cognitive profiles were identified: (a) "unimpaired" (19.9%); (b) weakness in verbal learning and memory (15.5%); (c) weakness in executive function and learning (25.8%); (d) weakness in motor, processing speed, and executive function (8.1%); (e) impaired learning and recall with weak-to-impaired motor, processing speed, and executive function (13.1%); (f) global deficits (17.6%). The most discriminative sociodemographic, clinical/behavioral, and HIV disease characteristics varied by profile with self-reported mood symptoms and cognitive/functional difficulties (e.g., language/communication, memory, and overall everyday function complaints) most consistently associated with profile membership. Conclusions: Cognitive profiles and their associated factors among PWH are heterogeneous, but learning/memory deficits were most common and self-reported mood, and cognitive/ functional difficulties were most consistently related to profile membership. This heterogeneity in cognitive profiles and their correlates in PWH suggests that differing mechanisms contribute to cognitive deficits and, thus, underscores the need for personalized risk reduction and therapeutic strategies among PWH. Key PointsQuestion: Are there common profiles of cognitive impairment among virally suppressed PWH and what are their sociodemographic and health-related correlates? Findings: We found that profiles of cognitive impairment were heterogeneous among PWH although learning/memory deficits were most common and self-reported mood and cognitive/functional difficulties most consistently related to profile membership. Importance: Findings suggest that differing mechanisms contribute to cognitive deficits among PWH and, thus, personalized approaches are needed for risk reduction and therapeutic strategies for cognitive impairment. Next Steps: Future research should examine cognitive profiles in relation to biomarkers to inform mechanisms and test the trajectory of the profile groups over time.