Antiretroviral therapy has turned HIV into a manageable disease that has greatly extended the lives of millions. As a result, researchers have started to study HIV through the chronic disease lens. They have compared how living with managed HIV compares with living with other managed, chronic conditions, such as diabetes and rheumatoid arthritis. They have also started to look into “successful aging” in people with HIV and how the condition (and the medications used to manage it) affect people’s quality of life. One major component of successful aging is neurocognitive capabilities and arresting their decline. Although cases of HIV-related dementia have decreased with the advent of antiretroviral. there are still subtler neurocognitive problems associated with HIS.
Results of an NIH-funded study reported in PLOS One last week shed more light on the subject of HIV as a chronic disease and, in particular, on the relationship between neurocognitive impairment and quality life. A team of researchers at the University of Nebraska used data collected during four years of the longitudinal CHARTER study, a research project that enrolled just over 2,000 patients at six university-based clinics. After some exclusions because of missing data and confounding comorbidities, the Nebraska researchers zeroed in on a smaller group of 1,340 study participants, most (77%) of whom were male and whose average age was 43. They combed through the answers the study participants gave to
At the heart of the study is their examination of the association between neurocognitive impairment and health-related quality of life (HRQoL). They combed through the answers that the patients gave to a 35-item questionnaire called the Medical Outcome HIV Health Survey and grouped them in such a way as to create a summary score for the person’s mental HrQoL and their physical one.
The results were not hugely surprising and fit with previous findings, although the CHARTER study gave the researchers access to more data on a more diverse group of people than prior studies. The takeaway finding is that neurocognitive impairment, as measured by a global deficit score, is associated with worse mental HRQoL among people living with HIV, although the analysis threw some doubt on clinical importance of the association. They also found that depression may have been a factor in the impairment-mental HRQoL association, and one of their recommendations was that people with HIV with neurocognitive impairment might benefit from concurrent management of depression.
The relationship between neurocognitive impairment and physical HRQoL was not as strong and disappeared after statistical adjustments for age and other factors.
These findings will not disrupt or reframe the current thinking about people living with HIV and the challenges they face. But they do paint a fuller picture of HIV as a chronic disease that presents the mental health and quality-of-life challenges that are common to many health conditions that are eminently treatable but not curable.