Cognitive Concerns are a Risk Factor for Mortality in People with Human Immunodeficiency Virus and COVID-19
Emily Rudmann1, Douglas Wilcox4, Elissa Ye2, Ayush Noori2, Colin Magdamo2, Aayushee Jain2, Haitham Alabsi2, Virginia Triant3, Gregory Robbins3, M. Brandon Westover2, Sudeshna Das2, Shibani Mukerji1
1Neurology, Neuroimmunology and Neuro-Infectious Diseases Division, 2Neurology, 3Infectious Diseases, Massachusetts General Hospital, 4Neurology, Brigham and Women's Hospital, Harvard Medical School
Objective:
To assess the contribution of cognitive symptoms to risk of mortality from COVID-19 in people with HIV (PWH).
Background:
Despite higher prevalence of cognitive disorders in PWH and dementia being a risk factor for COVID-19 mortality, the association between cognitive impairment and adverse outcomes in PWH with COVID-19 has not been well established.
Design/Methods:
Matched case-control study (1:10) of PWH and without (PWoH) with documented SARS-CoV-2 PCR positivity from March 2020-March 2021 evaluated at a Boston-based healthcare system. Data were extracted from the electronic health record. Matching was on age, sex, race, and zip code. Primary exposures were dementia (ICD-10 code) and cognitive concerns (concern for impairment within 12 months pre-COVID-19, ascertained using a semi-automated chart annotation tool). VACS2.0 Index (including general and HIV-specific biomarkers) was calculated. VACS2.0 Index-adjusted logistic regression models assessed effect of dementia and cognitive concerns on odds of death (OR[95% confidence interval]).
Results:
Among 14,129 patients with COVID-19, 64 PWH were identified and matched to 463 PWoH. Among PWH, 89% were on antiretroviral therapy, 87% had an HIV-1 viral load <200 copies/mL, and 19% had CD4 <200 cells/μL. VACS2.0 score predicted level of care and mortality in both PWH and PWoH. PWH had higher prevalence of dementia (16% vs. 6%,p=0.01) and cognitive concerns (22% vs. 16%,p=0.04). Death was more frequent in PWH (17% vs. 6%,p<0.01), at younger ages (58 vs. 66 years,p=0.03). VACS2.0-adjusted regression models found cognitive concerns (2.4[1.1-5.3],p=0.03) and dementia (2.4[1.0-5.8],p=0.05) significantly associated with odds of death in the overall group. Among PWH only, aOR for cognitive concern approached significance (3.9[0.81-20.19],p=0.09), while dementia (1.75[0.29-8.71],p=0.50) did not.
Conclusions:
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. Assessment of cognitive status is an important component to care for PWH in the COVID-19 era.