Neurocognitive course at two-year follow-up in the neurocognitive assessment in the metabolic and aging cohort (NAMACO) study.

Abstract

OBJECTIVE

To examine neurocognitive course over time among people with well-treated HIV.

DESIGN

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is an ongoing, prospective, longitudinal, multicenter and multilingual study within the Swiss HIV Cohort Study (SHCS). Participants undergo neuropsychological assessment at baseline and two-yearly follow-up.

SETTING

Seven SHCS centers.

SUBJECTS

Patients aged ≥45 years enrolled in the SHCS with fluency in the local language (French, German or Italian) and agreeing to participate in the NAMACO study: 981 participants at baseline, 720 at two-year follow-up of whom 644 had complete data sets.

INTERVENTION

Standardized neuropsychological assessment at baseline and two-year follow-up.

MAIN OUTCOME MEASURE

Neurocognitive performance using Frascati criteria and mean z-scores.

RESULTS

Four participants (of 644, 0.6%) had plasma HIV-1 RNA > 50 copies/mL; median CD4 count was 660 cells/μL. According to Frascati criteria, 204 participants (31.7%) had neurocognitive impairment (NCI) at baseline. NCI severity in these participants changed little over two years and comprehensive models based on Frascati criteria were not feasible. Examining mean z-scores, however, we observed neurocognitive stability or improvement over two years in five of seven neurocognitive domains assessed. Age ≥65 years (p = 0.02) and cognitive complaints (p = 0.004) were associated with neurocognitive decline, while black race (p = 0.01) and dolutegravir treatment (p = 0.002) were associated with improvement.

CONCLUSION

Frascati criteria were less sensitive in measuring NCI change and therefore unsuitable for following neurocognitive course in our cohort of people with well-treated HIV. Examining neurocognitive course by mean z-score change, we observed stability or improvement.