Association of HIV infection and cognitive impairment in older adults: A meta-analysis

Luojia Deng; Xuezhixing Zhang; Yanxiao Gao; DeAnne Turner; Frank Qian; Hui Lu; Sten H Vermund; Yue Zhang; Han-Zhu Qian

doi:10.1016/j.arr.2021.101310

Association of HIV infection and cognitive impairment in older adults: A meta-analysis

Ageing Res Rev. 2021 Jul:68:101310. doi: 10.1016/j.arr.2021.101310. Epub 2021 Feb 26.

Authors

Luojia Deng¹, Xuezhixing Zhang², Yanxiao Gao³, DeAnne Turner⁴, Frank Qian⁵, Hui Lu⁶, Sten H Vermund⁷, Yue Zhang⁸, Han-Zhu Qian⁹

Affiliations

¹ Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Ting University, Shanghai, China. Electronic address: soramafu@sjtu.edu.cn.
² Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Ting University, Shanghai, China. Electronic address: zxzx1248@sjtu.edu.cn.
³ School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China. Electronic address: yxgao2016@163.com.
⁴ Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA; School of Public Health, Yale University, New Haven, CT, USA. Electronic address: deanne.turner@yale.edu.
⁵ Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: fqian@bidmc.harvard.edu.
⁶ Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Ting University, Shanghai, China; SJTU-Yale Joint Center for Biostatistics and Data Science, Shanghai Jiao Tong University, Shanghai, China. Electronic address: huilu@sjtu.edu.cn.
⁷ School of Public Health, Yale University, New Haven, CT, USA. Electronic address: sten.vermund@yale.edu.
⁸ Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Ting University, Shanghai, China; SJTU-Yale Joint Center for Biostatistics and Data Science, Shanghai Jiao Tong University, Shanghai, China. Electronic address: yue.zhang@sjtu.edu.cn.
⁹ School of Public Health, Yale University, New Haven, CT, USA; SJTU-Yale Joint Center for Biostatistics and Data Science, Shanghai Jiao Tong University, Shanghai, China. Electronic address: han-zhu.qian@yale.edu.

Abstract

Objective: To synthesize evidence on the association between human immunodeficiency virus (HIV) infection and cognitive impairment in older adults.

Design: Meta-analysis.

Participants: Adults aged 50 years or older.

Methods: In this systematic literature review and meta-analysis, we searched PubMed, Scopus, Embase, and APA/PsycNet for studies published before July 21, 2020, that assessed the association between HIV-infection and cognitive impairment. We calculated pooled odds ratios (ORs) of cognitive impairment for people living with HIV (PLWH) and 95 % confidence intervals (CIs) using random-effect models and calculated pooled mean difference (MD) for major cognitive domains between PLWH and HIV-uninfected adults. We assessed risk of bias using the Newcastle-Ottawa scale.

Results: Of the 4432 studies identified, 21 cross-sectional studies were eligible for the meta-analysis, including 15 examining global cognitive impairment. The meta-analysis showed that older PLWH were more likely to be cognitively impaired than HIV-uninfected controls (OR = 2.44, 95 % CI = [1.69, 3.53], number of estimates (k) = 15, I² = 71 %). This higher likelihood was shown in studies from high income countries (OR = 2.63, 95 % CI = [1.76, 3.94], k = 12, I² = 55 %), but not from upper-middle income countries (OR = 1.96, 95 % CI = [0.26, 14.68], k = 3, I² = 91 %). PLWH had lower scores than HIV-uninfected adults in 5 out of 7 major cognitive domains, including executive function (MD = -0.42, 95 % CI = [-0.72, -0.11], k = 5, I² = 32 %), processing speed (MD = -0.33, 95 % CI = [-0.59, -0.08], k = 6, I² = 16 %), verbal (MD=-0.29, 95 % CI = [-0.48, -0.10], k = 6, I² = 0%), recall (MD = -0.24, 95 % CI = [-0.38, -0.10], k = 6, I² = 0%) and motor/psychomotor (MD = -0.38, 95 % CI = [-0.59, -0.16], k = 5, I² = 31 %) performance.

Conclusions/implications: Our meta-analysis provides empirical evidence that HIV infection is associated with an increased risk of cognitive impairment among older adults, especially in cognitive domains of executive function, processing speed, verbal, recall, and motor/psychomotor.

Keywords: Cognitive domain; Cognitive impairment; HIV; Meta-analysis; Older people living with HIV.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Aged
Cognition
Cognitive Dysfunction* / epidemiology
Cross-Sectional Studies
HIV Infections* / complications
HIV Infections* / epidemiology
Humans

Grants and funding

P30 MH062294/MH/NIMH NIH HHS/United States