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HIV and risk of dementia in older veterans
Author(s) -
Bobrow Kirsten,
Xia Feng,
Hoang Tina D,
Valcour Victor,
Yaffe Kristine
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.041515
Subject(s) - medicine , dementia , hazard ratio , confounding , confidence interval , medical record , comorbidity , gerontology , disease
Background People living with HIV (PLWH) may be at increased risk for dementia because of increased major risk factors, chronic infection (and inflammation), and long‐term use of highly active antiretroviral therapy (HAART). Our goal was to determine whether HIV‐infection is associated with incident dementia diagnosis in older U.S. veterans accounting for important potential confounders and competing risk of death. Methods We included 1114 veterans, ages ≥ 55 years (mean age=62 years, SD 6), with HIV in the Veterans Health Administration health care system from 2004 to 2015, and a propensity‐matched comparison group (n= 1114) without HIV. HIV and dementia diagnoses were determined using International Classification of Diseases, Ninth Revision codes and Diagnostic Related Group codes in electronic medical records. We conducted Fine‐Gray proportional hazards models to determine whether HIV status was associated with greater risk of incident dementia and adjusting for demographics and co‐morbidities. Result During follow‐up (mean=7 years, SD 4 from date of HIV diagnosis) 5% of veterans living with HIV developed dementia compared to 3% without (p=0.01). Accounting for the competing risk of death, in a model adjusted only for demographics, veterans with HIV had a 60% increased risk of dementia compared to those without HIV (adjusted hazard ratio 1.59, 95% confidence interval, CI, 1.04 ‐2.43.) In a model adjusted for age, sex, race, substance use, education and income PLWH were still 50% more likely to receive a dementia diagnosis (aHR 1.50, 95% CI 0.96‐2.35). Conclusion In a cohort of older US veterans, we found that HIV infection increases risk of developing dementia. As the population of PLWH in the US ages, understanding general and unique dementia risk factors for this group is key to developing appropriate prevention and mitigation strategies.