CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

636

Association of Delayed HIV Diagnosis or ART Initiation With Risk of Age-Associated Dementia Jennifer O. Lam 1 , Catherine Lee 1 , Craig Hou 2 , Dongjie Fan 3 , Haihong Hu 4 , Errol Lopez 5 , William Towner 5 , Michael Horberg 4 , Michael Silverberg 1 1 Kaiser Permanente Northern California, Oakland, CA, USA, 2 Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA, 3 Kaiser Permanente Division of Research, Oakland, CA, USA, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 5 Kaiser Permanente Southern California, Pasadena, CA, USA Background: Recent studies have reported that older adults with HIV infection are at elevated risk of age-associated dementia despite antiretroviral therapy (ART). We investigated the hypothesis that delayed HIV diagnosis or initiation of ART could contribute to greater risk of developing dementia later in life. Methods: We conducted a retrospective cohort study of people with HIV who received care at Kaiser Permanente healthcare systems in Northern California, Southern California, and Mid-Atlantic States (Maryland, Virginia, Washington DC) between 1/1/2000 and 12/31/2023. Included individuals were aged ≥50, had at least 1 documented ART prescription fill, at least 1 year of continuous health plan enrollment, and no prior diagnosis of dementia. Low CD4 count (i.e., <200 cells/µl) at 1st documented ART prescription fill was used as a proxy for delayed HIV diagnosis or ART initiation. The outcome of interest was incident dementia, identified using ICD codes in the electronic health record. The association of low CD4 count at 1st ART prescription with incident dementia was evaluated using Cox regression, with age as the time scale and adjustment for the following covariates: HIV RNA level at 1st ART prescription, calendar year of 1st ART prescription (to account for temporal trends in ART prescription), sex, race/ethnicity, neighborhood-level education, smoking, substance use disorders, depression, cardiovascular disease, diabetes, hepatitis C infection, obesity, and number of outpatient visits in the year before study inclusion. To account for the competing risk of death, a sensitivity analysis was done using a Fine-Gray subdistribution hazard model. Results: The study included 23,201 people with HIV with documented ART prescriptions (mean age at study inclusion: 54.0 years, 87.1% men, 46.1% White, 22.7% Black, 20.7% Hispanic, 3.1% Asian or Pacific Islander, 6.6% other or unknown race/ethnicity). During follow-up (mean 6.8 years, SD: 5.8), we observed 748 cases of incident dementia. Low CD4 count at 1st ART prescription was associated with greater risk of developing dementia (adjusted hazard ratio: 1.24, 95% CI: 1.03-1.49; see Table). After accounting for deaths during follow-up, results were similar (adjusted hazard ratio: 1.23, 95% CI: 1.02-1.49). Conclusions: Findings suggest that delayed HIV diagnosis and ART initiation are associated with risk of developing age-associated dementia. These findings emphasize the importance of continuing assertive HIV screening in the community. Incidence and Risk Factors for Neurocognitive Disorders Among Persons With HIV in Washington, DC Shannon K. Barth 1 , Yun S. Ji 2 , Ellen Yeung 1 , Morgan Byrne 1 , Michael Horberg 3 , Anne Monroe 1 , Amanda D. Castel 1 , for the DC Cohort Executive Committee 1 The George Washington University, Washington, DC, USA, 2 Milken Institute School of Public Health, Washington, DC, USA, 3 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA Background: Development of neurocognitive disorders (ND) remains a concern among persons with HIV (PWH), despite advances in antiretroviral treatments (ART) which have aided in reducing ND incidence. Studies have indicated increased risk for ND among PWH with comorbidities such as obesity, cardiovascular disease (CVD), Hepatitis C, and toxoplasmosis. The purpose of this analysis was to determine the incidence, trends, and comorbidities associated with electronic health record (EHR)-based documented NDs among a longitudinal cohort of PWH in Washington, DC. Methods: Using EHR data from the DC Cohort, an ongoing longitudinal study of PWH in Washington, DC, from 1/12/11 through 6/30/24, we identified PWH with ICD codes indicative of NDs, classified as mild (e.g., mild cognitive impairment, delirium) or advanced (e.g., dementia, neurogenerative disorder), and medical comorbidities. We conducted bivariable analyses comparing those with and without ND. We calculated temporal trends for ND. Logistic regression analyses examined associations between ND and pre-diagnosis comorbidities, adjusting

used Group-Based Trajectory Analysis of B-CAM scores, using absolute (sensitive to initial value) and centered (more sensitive to change) values 2) to assess if shorter term decline predicted longer term decline, for each pair of visits of a given participant, we assessed meaningful change (≥ 0.5 SD difference), and compared proportions of episodes of such change in the stable and declining trajectories, and 3) among those with at least one episode of decline between visits, Poisson regression was used to compare those on a declining versus stable trajectory on personal characteristics. Results: Two trajectories of centered B-CAM were present: stable (68.7%) and declining (31.3%). Uncentered B-CAM had 5 patterns: low (intercept: 0.0, 4.9%), medium-low (0.7, 34.2%), intermediate (1.3, 41.9%), medium-high (1.9, 14.1%) and high (2.6, 4.9%). Trajectories of intermediate and higher uncentered B-CAM were less likely to follow a declining trajectory. Experiencing at least one episode of meaningful worsening between visits was common, 50% in the stable group and 100% in the overall declining group, and was associated with an increasing likelihood of a declining trajectory in older participants (RR 2.0 per decade). Conclusions: Over 10 years, more than half of OAWH had at least one meaningful worsening in cognitive performance which did not reliably predict long-term decline as only a quarter had sustained cognitive decline. Older individuals and those with worse overall performance were at higher risk. These findings suggest that shorter-term worsening need not portend longer-term decline, although it may be more worrisome in older people. Obstructive Sleep Apnea Contributes to Cognitive Difficulties Among Older Adults With HIV Marie-Josée Brouillette 1 , Mahra Aldahbashi 2 , Réjean Thomas 3 , Marianne Harris 4 , Graham Smith 5 , Fiona Smaill 6 , Shariq Haider 6 , Scott L. Letendre 7 , Susan Scott 8 , Lesley K. Fellows 9 , Nancy E. Mayo 8 1 McGill University Health Centre Research Institute, Montreal, Canada, 2 McGill University, Montreal, Canada, 3 Clinique Médicale l'Actuel, Montreal, Canada, 4 BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 5 Maple Leaf Medical Clinic, Toronto, Canada, 6 McMaster University, Hamilton, Canada, 7 University of California San Diego, La Jolla, CA, USA, 8 McGill University Health Centre, Montreal, Canada, 9 Montreal Neurological Institute, Montreal, Canada Background: Brain health disorders continue to occur in older adults with HIV (OAWH), underscoring the importance of addressing reversible causes. We sought to determine if obstructive sleep apnea (OSA) is associated with cognitive difficulties among OAWH. Methods: The + Brain Health Now cohort study enrolled 856 individuals aged 35 or older with HIV for ≥ 1 year from 5 HIV clinics in Canada between 2013-2016. Participants were assessed every 9-12 months for up to 10 years. We screened for the presence of OSA with the Berlin (low/high risk) and the STOP Bang (low/intermediate/high risk) questionnaires. Self-reported cognitive difficulties (SRCD) were assessed with the Patient-Deficit Questionnaire and the HIV-specific Communicating Cognitive Concerns. Rasch analysis was used to combine items to create a harmonized measure of Self-Reported Cognitive Difficulties (range -5.74 to 6.17, SD: 1.66). Performance-based cognition was measured with the B-CAM, a computerized battery of multiple domains (range -2.57 to 4.03, SD: 0.76). Generalized linear models analyzed associations between OSA screening, cognition, age, and sex. Results: 1881 assessments in 707 participants, who were mostly men (84.7%) with mean age 55.0 years (SD: 8.2). The proportion of visits with a positive OSA screen were 35.7% for the Berlin and, for the STOP-Bang, 35.5% with intermediate and 33.0% with high risk. More self-reported cognitive difficulties were associated with a positive screen on the Berlin (-0.38, 95% CI: -0.53 to -0.23) or positive screen in the high-risk category on the STOP-Bang (-0.35, -0.52 to -0.17), this latest also being associated with worse performance on the B-CAM (-0.11, -0.22 to -0.01). The presence of loud snoring, nearly daily breathing interruptions, and fatigue were predictive of cognitive difficulties. Conclusions: Among OAWH, over 1 in 3 individuals screened positive for OSA, which was associated with higher self-reported cognitive difficulties and worse performance-based cognition, although the impact was lower than the 0.5 SD generally considered clinically meaningful. Validation of the screening questionnaires and impact of treatment in HIV would be next steps. In the meantime, since the treatment of OSA has several health benefits, screening and treatment should be considered.

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Poster Abstracts

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CROI 2025 174