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Female sex is strongly associated with cognitive impairment in HIV infection

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Abstract

Background

Neurocognitive disorders remain frequent despite highly active antiretroviral treatment (HAART). The CNS is known as the sanctuary of HIV infection, where persistent neuroinflammation occurs regardless of viral suppression. Moreover, opportunistic infections, neurovascular damage and HAART neurotoxicity contribute to neurocognitive impairment. Therefore, detailed epidemiological studies might help to elucidate those complex mechanisms.

Objective

To investigate the prevalence of cognitive impairment and the associated sociodemographic, clinical and neuropsychological variables among HIV-infected patients admitted to a tertiary centre, in southern Brazil.

Methods

An observational, cross-sectional and analytic study was conducted between February 2019 and March 2020, in Hospital Nereu Ramos (HNR), with148 HIV-infected patients. They were interviewed, submitted to the International HIV Dementia Scale (IHDS) and had their medical data analysed.

Results

The prevalence of cognitive impairment was 69.6%. It was higher among women (OR = 3.5; 95% CI 1.5-8; p < 0.01), independently of depression, educational status and age. Full years of schooling were strongly associated with IHDS scores (p < 0.01). Patient Health Questionnaire-9 (PHQ-9) scores for depression (p = 0.8), time since HIV diagnosis (p = 0.2), CD4+ cell counts (p = 0.8) and viral load (p = 0.8) were not associated with IHDS scale.

Conclusion

A high prevalence of cognitive impairment in HIV-infected patients was identified, independently associated with the female sex and fewer years of schooling. Further studies are needed to clarify the differences in the pathophysiology between sexes and the role of cognitive reserve in prevention of cognitive impairment in HIV infection.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on request.

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Acknowledgments

We thank the staff from the Hospital Nereu Ramos for their support in this study, especially Dr. Sérgio Beduschi Filho.

Author information

Authors and Affiliations

  1. Universidade do Sul de Santa Catarina (UNISUL), Florianopolis, Santa Catarina (SC), Brazil

    Eric Andrius Coelho Duarte, André Luiz Pereira Martins, Edson Pillotto Duarte, Ana Beatriz Santandrea Weller & Laura Oliveira Coutinho de Azevedo

  2. Department of Neurology, Hospital Governador Celso Ramos (HGCR), Florianopolis, SC, Brazil

    Maria Luiza Benevides & Edson Pillotto Duarte

  3. Neuroative Neuropsychology Clinic, Florianopolis, SC, Brazil

    Maria Emília Rodrigues de Oliveira Thaís

  4. Division of Neuropathology, Universidade Federal de Santa Catarina (UFSC), Florianopolis, SC, Brazil

    Jean Costa Nunes

  5. Neurodiagnostic Brasil - Diagnósticos em Neuropatologia, Florianopolis, SC, Brazil

    Jean Costa Nunes

  6. Division of Neuropathology, Serviço de Anatomia Patológica, 1st floor Hospital Universitário Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina (UFSC), Professora Maria Flora Pausewang Street, Trindade, Florianopolis, SC, 88040-000, Brazil

    Jean Costa Nunes

Authors
  1. Eric Andrius Coelho Duarte
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  2. Maria Luiza Benevides
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  4. Edson Pillotto Duarte
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  5. Ana Beatriz Santandrea Weller
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Contributions

All the authors whose names appear on the submission contributed to the conception and design of the work. Duarte EAC, Benevides ML, Martins ALP, Weller ABS, and de Azevedo LOC contributed to the data acquisition. Duarte EAC, Benevides ML, Martins ALP, Duarte EP, Thaís MERO, and Nunes JC participated in the analysis and interpretation of data. Duarte EAC, Benevides ML, and Nunes JC drafted the work, and they and all the other authors revised it critically for important intellectual content. All the authors approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jean Costa Nunes.

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Conflicts of Interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethics Committee of HNR and Universidade do Sul de Santa Catarina (UNISUL) approved the study (Ethics approval number: 3.206.539).

Consent to participate

Informed consent was obtained from all patients before any procedure and evaluation.

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Not applicable.

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Duarte, E.A.C., Benevides, M.L., Martins, A.L.P. et al. Female sex is strongly associated with cognitive impairment in HIV infection. Neurol Sci 42, 1853–1860 (2021). https://doi.org/10.1007/s10072-020-04705-x

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