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Cognitive Phenotypes of HIV Defined Using a Novel Data-driven Approach
Robert H Paul1,2, Kyu Cho3, Andrew Belden3
1Department of Psychological Sciences, University of Missouri Saint Louis, Missouri, Saint Louis, US. paulro@umsl.edu.
Summary
Data-driven methods identified five cognitive phenotypes in people with HIV (PWH). Factors like substance use and brain structure influence cognitive impairment, highlighting the need for comprehensive care beyond ART adherence.
Area of Science:
- Neuroscience
- Infectious Diseases
- Psychiatry
Background:
- Human Immunodeficiency Virus (HIV) infection can lead to cognitive impairment, even with effective antiretroviral therapy (ART).
- Understanding distinct cognitive profiles in people with HIV (PWH) is crucial for targeted interventions.
- Previous research has not fully elucidated the complex interplay of factors contributing to cognitive dysfunction in PWH.
Purpose of the Study:
- To apply data-driven approaches to identify and characterize novel cognitive phenotypes in PWH.
- To determine the key demographic, clinical, and neuroimaging features associated with these cognitive phenotypes.
- To elucidate the multifactorial determinants of cognitive impairment in PWH on suppressive ART.
Main Methods:
- 388 people with HIV (PWH) underwent comprehensive cognitive testing and 3T neuroimaging.
- Hierarchical clustering was used to identify distinct cognitive phenotypes.
- Ensemble machine learning models were employed to delineate features differentiating cognitive clusters.
Main Results:
- Five distinct cognitive phenotypes were identified, ranging from normative performance to severe impairment across multiple domains.
- Cluster 5, characterized by significant impairment in action fluency, verbal learning/memory, and executive function, showed the highest prevalence of detectable HIV viral load.
- Machine learning identified polysubstance use, race, educational attainment, and specific brain region volumes (precuneus, cingulate, nucleus accumbens, thalamus) as significant predictors of cognitive impairment.
Conclusions:
- Cognitive impairment in PWH on suppressive ART is multifactorial, involving viral activity, psychosocial factors, and neurobiological changes.
- Psychosocial determinants, including race-based inequities and polysubstance use, warrant greater attention alongside viral suppression.
- Comprehensive, person-centered interventions addressing adherence, psychosocial factors, and cognitive health are essential for PWH.
