Cognitive function and mortality among persons aging with HIV and injection drug use

Cognitive impairment and frailty are critical, aging-related phenotypes prevalent among people with HIV (PWH). Yet, limited data exist isolating the determinants of cognitive function among persons with a history of injection drug use (PWID) with and at risk for HIV, or on the intersecting relationship of cognitive function and frailty with mortality in this population.

Standard cognitive assessments were performed among PWID with and without HIV in the AIDS Linked to the IntraVenous Experience (ALIVE) cohort. Frailty was assessed using the five Fried physical frailty phenotype criteria. An inflammatory index score was constructed from IL-6 and soluble TNF-α receptor-1 data. Cox proportional hazards models were utilized to estimate mortality risk.

Among 516 ALIVE participants, the median age was 52 years, and 41% were PWH. Hazardous alcohol use and older age were significantly associated with reductions in processing speed, motor function, and global cognitive function. In multivariable models, reduced processing speed, motor function, and global cognitive function were significantly associated with increased mortality. Reduced global cognitive function and frailty were independently associated with mortality. Reduced processing speed, motor function, executive function, and global cognitive function were significantly associated with heightened inflammation.

Reduced cognitive function is a significant predictor of death among PWH and PWID, independent of frailty, HIV disease stage, and comorbidity. Interventions that target both cognitive function and frailty, including those targeting inflammation pathways, among PWH and PWID may improve aging outcomes for these populations.