Declining Prevalence of Human Immunodeficiency Virus (HIV)-Associated Neurocognitive Disorders in Recent Years and Associated Factors in a Large Cohort of Antiretroviral Therapy-Treated Individuals With HIV.

Background: HIV-associated neurocognitive disorders (HAND) have been suggested as persistent even with effective antiretroviral therapy (ART). Aims were to evaluate HAND prevalence and associated factors, in a large cohort of people-with-HIV (PWH).
Methods: ART-treated PWH, underwent a neuropsychological examination through a battery of 12 tests exploring 5 different domains, between 2009 and 2020, were included in this cross-sectional analysis. HAND were classified according to Frascati's criteria. Participants were defined as complaining or not-complaining if a cognitive complaint was reported or not. Chi-square for trend and multivariable logistic regression were fitted.
Results: Overall, 1424 PWH were enrolled during four three-years periods. HAND prevalence was 24%; among complainers (572/1424), it was 38%, higher than among not-complainers (15%). Over the study period, a decreasing HAND prevalence was found in the entire population (P < 0.001) and in complaining (P < 0.001); in not-complaining it remained stable (P = 0.182). Factors associated with HAND were older age, lower educational level, lower current CD4+ T-cell count and HCV co-infection. Compared to nonnucleoside reverse transcriptase inhibitors, receiving dual and integrase strand transfer inhibitor (INSTI)-based therapies was associated with a decreased risk of HAND, as well as being tested in more recent years.
Conclusions: In this large cohort of ART-treated PWH, mostly virologically suppressed, a remarkable decreasing HAND prevalence was observed. Besides HIV- and patient-related factors, the reduced risk of HAND found with dual and INSTI-based regimens along with a more recent ART initiation, could suggest a potential role of new treatment strategies in this decline, due to their greater virologic efficacy and better tolerability.
Competing Interests: Potential conflicts of interest. Andrea Antinori has served as a paid consultant to and received payment or honoraria from Astra-Zeneca, Gilead Sciences, GlaxoSmithKline, Janssen-Cilag, Merck Sharp and Dohme, Roche, Theratotecnologies, ViiV Healthcare. Rita Bellagamba reports payment or honoraria from Merck Sharp and Dohme, and participation on a Data Safety Monitoring Board or Advisory Board from ViiV Healthcare, Gilead Sciences, and Merck Sharp and Dohme. Marta Camici received institutional grant and support for attending meetings and/or travel from Gilead Sciences. Stefania Cicalini reports consulting fees paid to self from ViiV Healthcare, Jansen-Cilag, Merck Sharp and Dohme, Gilead Sciences; payment or honoraria from ViiV Healthcare, Jansen-Cilag, Merck Sharp and Dohme, and Gilead Sciences. Roberta Gagliardini reports payments to their institution from Gilead Sciences, speakers' honoraria/educational activities for ViiV Healthcare, Merck Sharp and Dohme and Gilead Sciences, support for attending meetings and/or travel from ViiV Healthcare, advisor for Theratechnologies, Janssen-Cilag and Gilead Sciences. Ilaria Mastrorosa received institutional grant and support for attending meetings and/or travel from Gilead Sciences. Carmela Pinnetti received personal fee from Gilead Sciences for a case presentation and a travel grant and served on an advisory board for Janssen-Cilag. Alessandra Vergori received institutional grant from Gilead Sciences, speakers' honoraria/educational activities for Merck Sharp and Dohme and Janssen-Cilag, advisor for Janssen-Cilag. The other co-authors declare no conflicts of interests.
(© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)