Cognitive Concerns May Be a Marker for COVID-19 Mortality Among People With HIV

Among people living with human immunodeficiency virus (HIV) who become ill with COVID-19, cognitive concerns at baseline may increase mortality risk, according to study results presented at the 2023 American Academy of Neurology (AAN) Annual Meeting, held from April 22 to 27, in Boston, Massachusetts.

Cognitive disorders are more common among people with HIV, and dementia is a known risk factor for COVID-19 mortality. Despite these associations, little is known about the risks for COVID-19 mortality among people with HIV and cognitive concerns.

Researchers conducted a matched case-control study at Massachusetts General Hospital and Brigham and Women’s Hospital. Between March 2020 and 2021, people with HIV who had confirmed SARS-CoV-2 were matched in a 1:10 ratio with non-HIV control individuals with SARS-CoV-2. Electronic medical records were assessed for documented cognitive concerns or dementia in the 12 months before COVID-19; and, cognitive status was related with COVID-19 mortality risk.

Among the 14,129 patients with COVID-19, 64 people with HIV were matched with 463 control individuals.

Most people with HIV were receiving antiretroviral therapy (89%) and had an HIV-1 viral load less than 200 copies/mL (87%); and, a minority had a CD4 T-cell count less than 200 cells/mL (19%).

People with HIV had elevated rates of dementia (16% vs 6%; P =.01) and cognitive concerns (22% vs 16%; P =.04) compared with control individuals, respectively.

Patients with HIV were also more likely to have a higher COVID-19 mortality rate (17% vs 6%; P <.01). And among those who died, mortality occurred at a younger age (58 vs 66 years; P =.03) compared with control individuals, respectively.

In the adjusted regression analyses, risk for COVID-19 mortality associated with cognitive concerns (adjusted odds ratio [aOR], 2.4; 95% CI, 1.1-5.3; P =.03) and dementia (aOR, 2.4; 95% CI, 1.0-5.8; P =.05) among the entire study population. In the cohort of people with HIV, COVID-19 mortality tended to be associated with cognitive concerns (aOR, 3.9; 95% CI, 0.81-20.19; P =.09), but no association with dementia was observed (aOR, 1.75; 95% CI, 0.29-8.71; P =.50).

This study may have included miscoded or missing information, as it relied on medical coding data.

These data indicated that cognitive function may be an important mortality risk predictor among people with HIV who test positive for COVID-19. The researchers concluded, “Dementia and cognitive concerns were associated with mortality among people with COVID-19, and the magnitude of the effect of cognitive impairment may be greater in PWH [people with HIV]. Assessment of cognitive status is an important component to care for PWH in the COVID-19 era.”