Study: Cognitive Impairment in Patients with HIV Not Exacerbated by COVID-19 in Vaccinated Individuals

New research has found that patients living with HIV performed worse on cognitive tests in the first 4 months following SARS-CoV-2 infection compared to those without HIV, but these differences appear to be attributable to HIV rather than COVID-19.

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The study included a mostly vaccinated cohort of patients and was led by experts from the Johns Hopkins University School of Medicine. According to the findings, the study also suggests that processing speed is impaired in the months following COVID-19 in vaccinated patients without HIV.

Neurocognitive dysfunction is common in both long COVID as well as HIV. In the general population, brain fog, memory, and concentration issues are commonly reported after COVID-19. Similarly, HIV affects brain function and results in difficulties in attention, concentration, decision-making, and memory. However, researchers do not know whether those with and without HIV have different neurocognitive symptoms or sequelae following COVID-19.

A recent study found that those living with HIV are more likely to complain of neurocognitive symptoms post-COVID-19, and the researchers explored this further in the new study of 294 adults living in the lower 48 states who were enrolled in the Foundation for AIDS Research-Johns Hopkins University COVID Recovery Study. That study is investigating the long-term effects of COVID-19 in individuals with and without HIV.

Because HIV-Associated Neurocognitive Disorder (HAND) is experienced by up to 50% of those living with HIV, the investigators simultaneously assessed this population, as well as those without HIV who believed they had never had COVID-19, to determine whether differences in cognition measured by neurologic testing associate with HIV or COVID-19.

Between June 2021 and January 2023, 294 adults were enrolled into 4 study arms: those with HIV who had SARS-CoV-2 infection for the first time within 30 days before enrollment (N=56, arm 1); those without HIV who had SARS-CoV-2 infection for the first time within 30 days before enrollment (N=105, arm 2); those with HIV and with no history of SARS-CoV-2 infection (N=66, arm 3); and those without HIV and with no history of SARS-CoV-2 (N=67, arm 4). Additionally, 94% of the total participant population had received a COVID-19 vaccine prior to enrollment.

All participants underwent a series of 11 cognitive assessments by telephone at 1 and 4 months after COVID-19 symptom onset (arms 1 and 2) and at 1 and 4 months after enrolment for those who had never had COVID-19 (arms 3 and 4). Researchers then calculated age-standardized scores for all assessments and age-, sex-, and education-standardized scores for verbal fluency.

According to the results, among those with a history of COVID-19, those with HIV scored lower than those without HIV on crystallized cognition (general knowledge-type assessments), verbal memory, and fluency at 1-month post-COVID-19, after controlling for age, sex, years of education, and body mass index. The crystallized cognition test was also adjusted for COVID-19 vaccination, and verbal fluency tests were additionally adjusted for race, income category, and recreational drug use. The differences in verbal memory and category-cued verbal fluency persisted for at least 4 months post-COVID-19.

However, the investigators found no significant differences in any of the 11 cognitive assessments between those living with HIV with and without a history of COVID-19 at 1 month post-infection or enrollment, respectively. This suggests that the differences in cognition between those with and without HIV after COVID-19 infection were due to HIV rather than COVID-19.

“Our research is the first to suggest that post-COVID differences in cognition between people living with HIV and without HIV are likely more so due to HIV rather than COVID-19,” said researcher Alisha Dziarski, MD, in the press release. “The cognitive changes we observed that were attributable to COVID-19 were in our HIV-negative participants. Processing speed was decreased at 1 and 4 months post-COVID in people without HIV.”

When examining those without HIV, the analyses found that respondents with a history of COVID-19 performed worse on processing speed than those who had never had COVID-19 at both 1 and 4 months, after controlling for age, sex, years of education, body mass index, and recreational drug use. Respondents without HIV also scored lower on verbal memory and verbal fluency at 1 month post-COVID-19 but showed improvements by 4 months.

“Our findings underscore the importance for health care professionals to be vigilant to these longer-lasting neurological symptoms in people living with and without HIV who have had COVID-19, and for researchers to include control populations with HIV,” Dziarski said in the press release.

REFERENCE

Cognitive impairment in people living with HIV not made worse by COVID-19 in those who are vaccinated, US study suggests. News release. EurekAlert. April 3, 2023. Accessed April 5, 2023. https://www.eurekalert.org/news-releases/984678