Depression, lifestyle factors and cognitive function in people living with HIV and comparable HIV-negative controls

the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Objectives: We investigated whether differences in cognitive performance between people living with HIV (PLWH) and comparable HIV-negative people were mediated or moderated by depressive symptoms and lifestyle factors. Methods: A cross-sectional study of 637 ‘older’ PLWH aged ≥ 50 years, 340 ‘younger’ PLWH aged < 50 years and 276 demographically matched HIV-negative controls aged ≥ 50 years enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study was performed. Cognitive function was assessed using a computerized battery (CogState). Scores were standardized into Z-scores [mean = 0; standard deviation (SD) = 1] and averaged to obtain a global Z-score. Depressive symptoms were evaluated via the Patient Health Questionnaire (PHQ-9). Differences between the three groups and the effects of depression, sociodemographic factors and lifestyle factors on cognitive performance were evaluated using median regression. All analyses accounted for age, gender, ethnicity and level of education. Results: After adjustment for sociodemographic factors, older and younger PLWH had poorer overall cognitive scores than older HIV-negative controls (P < 0.001 and P = 0.006, respectively). Moderate or severe depressive symptoms were more prevalent in both older (27%; P < 0.001) and younger (21%; P < 0.001) PLWH compared with controls (8%). Depressive symptoms (P < 0.001) and use of hashish (P = 0.01) were associated with lower cognitive function; alcohol consumption (P = 0.02) was associated with better cognitive scores. After further adjustment for these factors, the difference between older PLWH and HIV-negative controls was no longer significant (P = 0.08), while that between younger PLWH and older HIV-negative controls remained significant (P = 0.01). Conclusions: Poorer cognitive performances in PLWH compared with HIV-negative individuals were, in part, mediated by the greater prevalence of depressive symptoms and recreational drug use reported by PLWH.

Original languageEnglish
Pages (from-to)274-285
Number of pages12
JournalHIV Medicine
Volume20
Issue number4
DOIs
Publication statusPublished - Apr 2019

Bibliographical note

Funding Information:
We thank all participants in the study. Financial disclosure: This study was funded by investigator initiated grants from BMS, Gilead Sciences, Janssen, Merck and ViiV Healthcare (EudraCT Number: 2012-003581-40; Sponsor Protocol Number: CRO1992). The study was also supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London and by an NIHR Senior Investigator Award to Professor C. A. Sabin. MB has received speaking fees from Gilead, MSD/Merck and Janssen, advisory fees from ViiV, Gilead and MSD/Merck, honoraria from Gilead for speakers' bureaus and a travel grant from Gilead and has been the principal investigator in clinical trials sponsored by Gilead, ViiV, Mylan, Janssen and Bristol-Meyers Squibb. FAP has received research grants from Gilead Sciences and ViiV Healthcare, and fees from Gilead Sciences, ViiV Healthcare, MSD and Janssen for membership of advisory boards and speaker panels and/or for the preparation of educational materials. PWGM has received funding for membership of advisory boards and speaker panels, and preparation of educational materials, and/or research grants to his institution from Gilead Sciences, ViiV Healthcare, BMS, MSD, Abbvie and Janssen-Cilag. JA has received grants, personal fees and nonfinancial support from Gilead Sciences, MSD, Janssen and BMS, and nonfinancial support from ViiV.

Funding Information:
Financial disclosure: This study was funded by investigator initiated grants from BMS, Gilead Sciences, Jans-sen, Merck and ViiV Healthcare (EudraCT Number: 2012-003581-40; Sponsor Protocol Number: CRO1992). The study was also supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London and by an NIHR Senior Investigator Award to Professor C. A. Sabin. MB has received speaking fees from Gilead, MSD/Merck and Janssen, advisory fees from ViiV, Gilead and MSD/Merck, honoraria from Gilead for speakers’ bureaus and a travel grant from Gilead and has been the principal investigator in clinical trials sponsored by Gilead, ViiV, Mylan, Janssen and Bristol-Meyers Squibb. FAP has received research grants from Gilead Sciences and ViiV Healthcare, and fees from Gilead Sciences, ViiV Healthcare, MSD and Janssen for membership of advisory boards and speaker panels and/ or for the preparation of educational materials. PWGM has received funding for membership of advisory boards and speaker panels, and preparation of educational materials, and/or research grants to his institution from Gilead Sciences, ViiV Healthcare, BMS, MSD, Abbvie and Jans-sen-Cilag. JA has received grants, personal fees and nonfinancial support from Gilead Sciences, MSD, Janssen and BMS, and nonfinancial support from ViiV.

Publisher Copyright:
© 2019 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association

Keywords

  • HIV
  • HIV-associated neurocognitive disorders
  • cognitive disorder
  • cognitive function
  • depression
  • people living with HIV

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