Cognitive concerns are a risk factor for mortality in people with HIV and coronavirus disease 2019
Wilcox, DR; Rudmann, EA; Ye, E; et al., AIDS
Published
August 2023
Journal
AIDS
Abstract
Background: Data supporting dementia as a risk factor for coronavirus disease 2019 (COVID-19) mortality relied on ICD-10 codes, yet nearly 40% of individuals with probable dementia lack a formal diagnosis. Dementia coding is not well established for people with HIV (PWH), and its reliance may affect risk assessment.
Methods: This retrospective cohort analysis of PWH with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR positivity includes comparisons to people without HIV (PWoH), matched by age, sex, race, and zipcode. Primary exposures were dementia diagnosis, by International Classification of Diseases (ICD)-10 codes, and cognitive concerns, defined as possible cognitive impairment up to 12 months before COVID-19 diagnosis after clinical review of notes from the electronic health record. Logistic regression models assessed the effect of dementia and cognitive concerns on odds of death [odds ratio (OR); 95% CI (95% confidence interval)]; models adjusted for VACS Index 2.0.
Results: Sixty-four PWH were identified out of 14 129 patients with SARS-CoV-2 infection and matched to 463 PWoH. Compared with PWoH, PWH had a higher prevalence of dementia (15.6% vs. 6%, P = 0.01) and cognitive concerns (21.9% vs. 15.8%, P = 0.04). Death was more frequent in PWH ( P < 0.01). Adjusted for VACS Index 2.0, dementia [2.4 (1.0-5.8), P = 0.05] and cognitive concerns [2.4 (1.1-5.3), P = 0.03] were associated with increased odds of death. In PWH, the association between cognitive concern and death trended towards statistical significance [3.92 (0.81-20.19), P = 0.09]; there was no association with dementia.
Conclusion: Cognitive status assessments are important for care in COVID-19, especially among PWH. Larger studies should validate findings and determine long-term COVID-19 consequences in PWH with preexisting cognitive deficits.
Authors
Douglas R Wilcox, Emily A Rudmann, Elissa Ye, Ayush Noori, Colin Magdamo, Aayushee Jain, Haitham Alabsi, Brody Foy, Virginia A Triant, Gregory K Robbins, M Brandon Westover, Sudeshna Das, Shibani S Mukerji
Keywords
Humans; COVID-19/complications; SARS-CoV-2; COVID-19 Testing; Retrospective Studies; HIV Infections/complications; Risk Factors; Cognition; Dementia
Short Summary
Cognitive issues, such as memory problems and difficulty thinking clearly, may increase the risk of death from COVID-19, especially for people with HIV. Many people with cognitive issues never receive a formal diagnosis. This is particularly true for people with HIV, who face higher rates of HIV-related cognitive issues and age-related thinking problems. Researchers wanted to understand how pre-existing cognitive problems in people with and without HIV affect their risk of death from COVID-19.
The research team studied 64 people with HIV who tested positive for COVID-19 between March 2020 and March 2021. They compared them to 463 people without HIV, matched by age, sex, race, and zip code. First, they checked electronic medical records for dementia diagnoses. Then, they reviewed additional information including HIV characteristics from medical providers and reviewed clinical notes from the year before COVID-19 to identify “cognitive concerns.” These included any documented worries about memory loss, thinking problems, or prescriptions for medications used to treat cognitive symptoms. These data were analyzed to determine the relationship between pre-existing cognitive issues and death after COVID in people with HIV and people without HIV.
In the group of people without cognitive issues, 3.9% of people without HIV and 10% of people with HIV died following COVID infection. However, in the group with cognitive issues, 18% of people without HIV and 40% of people with HIV died after COVID infection. People with HIV who had documented preexisting cognitive issues before infection had roughly a threefold-increased odds of death after COVID infection.
These findings suggest that assessing thinking and memory problems is crucial for COVID-19 care, particularly for people with HIV. Many cognitive issues go undiagnosed, especially in vulnerable populations. Healthcare providers should carefully evaluate cognitive function when determining COVID-19 risk. Better cognitive screening could help identify those at highest risk for severe COVID-19 outcomes.