The Effects of Prescribed Medications on Depressive Symptoms and Neurocognitive Performance in People With Human Immunodeficiency Virus (HIV)

Asante R Kamkwalala; Avery Matthews; Ankita Garg; Upal Roy; Qing Ma; Maile Karris; Erin Sundermann; Ronald J Ellis; Patricia K Riggs; Mattia Trunfio; Jennifer Blanchard; David J Moore; Leah H Rubin; Scott L Letendre

doi:10.1093/cid/ciae518

The Effects of Prescribed Medications on Depressive Symptoms and Neurocognitive Performance in People With Human Immunodeficiency Virus (HIV)

Clin Infect Dis. 2024 Dec 10:ciae518. doi: 10.1093/cid/ciae518. Online ahead of print.

Authors

Asante R Kamkwalala¹, Avery Matthews², Ankita Garg³, Upal Roy⁴, Qing Ma⁵, Maile Karris⁶, Erin Sundermann⁷, Ronald J Ellis^{7

8}, Patricia K Riggs⁶, Mattia Trunfio⁷, Jennifer Blanchard⁶, David J Moore⁷, Leah H Rubin^{1

9

10}, Scott L Letendre^{6

7}

Affiliations

¹ Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.
² Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas, USA.
³ Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA.
⁴ Department of Health and Biomedical Sciences, University of Texas Rio Grande Valley, Brownsville, Texas, USA.
⁵ Department of Pharmacy Practice, University at Buffalo, Buffalo, New York, USA.
⁶ Department of Medicine, University of California, San Diego, California, USA.
⁷ Department of Psychiatry, University of California, San Diego, California, USA.
⁸ Department of Neurosciences, University of California, San Diego, California, USA.
⁹ Department of Psychiatry and Biological Sciences, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁰ Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.

PMID: 39658021
DOI: 10.1093/cid/ciae518

Abstract

Background: Alterations in brain function and structure, such as depression and neurocognitive impairment, continue to occur in people with human immunodeficiency virus (HIV, PWH) taking suppressive antiretroviral therapy (ART). The lifespan of PWH has improved but the healthspan remains worse than people without HIV, in part because of aging-related diseases. As a result, polypharmacy is common and increases the risk of drug-drug interactions and adverse reactions.

Methods: This cross-sectional project investigated the relationship between 7 medication-related metrics (including anticholinergic burden), depressive symptoms, and neurocognitive performance in 491 PWH at a single center in the United States. All participants were taking ART and had plasma HIV RNA ≤ 200 copies/mL.

Results: Participants had taken ART for a mean of 6.5 years, and most (57.6%) had CD4+ T-cells >500/µL. All 7 medication-related metrics were associated with worse global neurocognitive performance (P value <.0001 to .0087). Multivariable models confirmed that higher anticholinergic burden (P = .040) and use of benzodiazepines (P = .033), antidepressants (P = .0011), and more total medications (P = .059) were associated with more depressive symptoms (model P < .0001). Use of benzodiazepines (P = .0024) and opiates (P = .043) along with higher anticholinergic burden (P = .066) were also associated with worse neurocognitive performance. Benzodiazepine use was associated with worse performance in all domains and opiate use was associated with worse performance in processing speed, motor function, executive function, and working memory.

Conclusions: Use of benzodiazepines, opiates, and anticholinergic drugs contribute to cognitive and mood disorders in PWH. When possible, modifying or deprescribing medications may be beneficial.

Keywords: HIV; anticholinergic; cognition; depression; polypharmacy.

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Abstract

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