Neurocognitive performance and quality of life of older adults with HIV on antiretroviral treatment in Northern Thailand.

Introduction: With virologic suppression and longer life expectancy, older adults with HIV (OAHIV) are at risk for neurocognitive impairment (NCI). This study investigated neurocognitive performance, quality of life (QOL) and the association between OAHIV determinants.

Methods: This cross-sectional study was conducted in OAHIV aged ≥ 50 years on antiretroviral treatment at community hospitals in Northern Thailand between September and November 2020. The Montreal Cognitive Assessment Thai Version (MoCA-T) and the Thai-validated Medical Outcomes Study HIV (MOS-HIV) were used. NCI was defined as MoCA-T scores <25: 16-24 for amnestic mild cognitive impairment (aMCI) and <16 for dementia. For QOL, higher scores meant better QOL; a physical health summary T-score ≥50 was defined as good QOL.

Results: Overall, 269 OAHIV were enrolled; 59% were female and 99% had virologic suppression. The current median age was 61.8 years (interquartile range [IQR] 58.9-65.7). The median duration of antiretroviral treatment was 10.5 years (IQR 8.5-13.5). The current median CD4 count (234 tested) was 484 cells/mm (IQR 339-634), and 99% had plasma HIV RNA <40 copies/ml (229 tested). The median MoCA-T score was 20.0 (IQR 16.3-23.0). There were 234 OAHIV (87.3%) with NCI: 182 (67.9%) with aMCI and 52 (19.4%) with dementia. A hundred and ninety (70.6%) had good QOL. Bivariate analysis revealed no correlation between MoCA-T scores and QOL. Multivariable linear regression analysis revealed that MoCA-T score was associated with older age (r = -0.144, p = 0.002), lower education (r = 0.629, p < 0.001), lower income (r = 0.797, p = 0.040) and shorter treatment duration (r = 0.189, p = 0.006).

Conclusions: The vast majority of OAHIV with virologic suppression had NCI. Approximately two-thirds had a mild impairment and one-fifth had dementia. Neurocognitive performance and QOL were not correlated. Addressing mild NCI would enable more targeted monitoring. Early intervention and support could minimize functional impairment with increased age.