Background: Cognitive decline often follows human immunodeficiency virus (HIV) infection, yet the specific risk factors for developing Alzheimer's disease and related dementia (ADRD) in HIV patients remain elusive.
Method: To investigate the association between acquired immune deficiency syndrome (AIDS) status at the time of HIV diagnosis and the risk of ADRD, we conducted a retrospective cohort study using data from a nationwide claim database spanning 2008 to 2021. During the study period, 13,289 patients were newly diagnosed with HIV infection and were prescribed antiretroviral therapy (ART). Among them, a total of 3,929 individuals over 40 years old, with a follow-up exceeding 3 years and without dementia diagnosed within two months post-HIV diagnosis, were included. Cox proportional hazards regression models for ADRD requiring medication such as anti-cholinesterase inhibitor or memantine were performed using baseline presence of AIDS as a predictor, after adjusting for age, sex, insurance type, and comorbidities.
Result: Among the 3,929 participants (median age: 45 [IQR 15] years; 90.9% male), with a median follow-up of 7.6 (IQR 5.0) years, 114 patients were diagnosed with ADRD. HIV individuals with AIDS at baseline had a higher risk of ADRD (hazard ratio [HR], 2.21; 95% confidence interval [CI], 1.51 - 3.31) compared to those without AIDS. The risk was more prominent in individuals under 50 years old (HR, 5.39; 95% CI, 2.22 - 13.05) than in those 50 years or older (HR, 1.68; 95% CI, 1.07 - 2.63; P for interaction = 0.03).
Conclusion: This study underscores the need to stratify the management of cognitive impairment in newly diagnosed HIV patients based on their baseline AIDS status and age.
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