A study reveals that the impact of neurocognitive disorders varies depending on the sex assigned at birth, race, age or employment status

The neurodegenerative disorder associated with HIV leads to a decrease in the quality of life of any person, but especially affects older women with depression who have precarious jobs or are unemployed, particularly white and Latina women. This is the main finding of an American study whose results have been published in the journal PLOS ONE.

People with HIV are at risk of experiencing neurocognitive impairment which, as mentioned, can have negative consequences for their quality of life. The advent of highly active antiretroviral therapy (HAART) led to a decline in the prevalence of HIV-associated dementia cases. However, mild or moderate forms of infection-related neurocognitive disorders remain a problem.


An estimated 38 million people were living with HIV worldwide in 2019, making health-related quality of life an important health indicator for people with HIV. Numerous studies have shown that people with HIV experience neurocognitive impairment and are diagnosed with dementia earlier. On the other hand, situations of systematic marginalization (which in many cases also affect people with HIV) contribute to the appearance of mental health problems. In this sense, a recent study revealed that starvation was more strongly associated with cognitive decline than HIV.

In order to collect more data on this relevant topic, a team of researchers from the USA carried out a study that systematically analyzed the association between HIV-associated neurocognitive impairment, depression, and health-related quality of life in a A large and diverse sample of men and women with HIV in the US In addition, the impact of neurocognitive impairment on the quality of life of the participants was studied.

For their analysis, the team of researchers used data from the study Research on the Effects of Antiretroviral Treatment in HIV on the Central Nervous System (CHARTER), a prospective and observational trial carried out between 2003 and 2015 in which 1,340 people participated with the HIV with a mean age of 43 years. Three out of four participants were male, nearly half (47%) were black, 71% of the people were unemployed, and 42% suffered from depression. In addition, 54% of these people had other health problems and, specifically, 30% had what the researchers called comorbidities: brain trauma, epilepsy, major depression, alcohol use disorder, substance use (in that case). time or sometime in the past) or a low reading level.

The team of researchers examined the participants' scores on a number of mental and physical health indicators, such as pain perception, cognitive function, energy and fatigue, health discomfort, and overall quality of life. It was observed that the ratings of the people in the study on their quality of life were generally similar. However, the quantitative evaluations reflected another reality.

Thus, people with neurocognitive disorders experienced a decrease in quality of life indicators that was four times higher than that of people whose score did not meet the criteria to consider they had cognitive impairment. However, when performing the analysis taking into account age, sex assigned at birth, race, employment and use of psychiatric medication, the reduction in quality of life was half (2.5 times compared to 4 times).


Interestingly, it was the white participants - especially white or Latina women of any race with precarious or unemployed jobs - who experienced a greater decline in quality of life when they presented neurocognitive impairment. For example, overall, whites experienced a nearly six-fold decline in quality of life compared to their black peers. In addition, in the study, women were twice as likely as men to experience a poor quality of life when they had cognitive impairment.

The health-related quality of life of the participants did not decrease much until they were older. While 40-year-olds only experienced a 0.09-fold decrease in quality of life, after 60 years of age, the decrease in quality of life was four times greater.

The declines in quality of life were especially pronounced for the unemployed (a nine-fold decrease) and those taking psychiatric medication (an eight-fold decrease). As might be expected, the diagnosis of major depression was related to poorer cognitive function, as well as a poorer physical and mental quality of life. When excluding depression from the analysis, neurocognitive disorder was only associated with decreased mental, not physical, quality of life. The study did not examine a history of trauma or experiences of discrimination.

The authors concluded by noting that the findings of their study suggest the need to include the simultaneous management of depression in the strategies aimed at improving the quality of life associated with health among people with HIV with neurocognitive impairment.


Source: POZ / Own elaboration (gTt-VIH).
References: Amara PS, Naveed Z, Wichman CS, Fox HS, Baccaglini L. Neurocognitive impairment and health-related quality of life among people living with Human Immunodeficiency Virus (HIV) Published: April 1, 2021https://doi.org/10.1371/journal.pone.0248802

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