Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort study
Introduction Dementia is a progressive and debilitating disease, and people living with HIV (PLWH) often develop dementia much earlier than those not living with HIV. We estimated the incidence and prevalence of dementia and identified its key risk factors in a cohort of PLWH in British Columbia, Ca...
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BMJ Publishing Group
2024-04-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/2/1/e000627.full |
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| author | Rolando Barrios Julio S G Montaner Silvia Guillemi Ni Gusti Ayu Nanditha Viviane D Lima Thomas L Patterson Fidel Vila-Rodriguez William G Honer Jason Trigg Hasan Nathani Sara Shayegi-Nik Weijia Yin Alejandra Fonseca Bronhilda T Takeh |
| author_facet | Rolando Barrios Julio S G Montaner Silvia Guillemi Ni Gusti Ayu Nanditha Viviane D Lima Thomas L Patterson Fidel Vila-Rodriguez William G Honer Jason Trigg Hasan Nathani Sara Shayegi-Nik Weijia Yin Alejandra Fonseca Bronhilda T Takeh |
| author_sort | Rolando Barrios |
| collection | DOAJ |
| description | Introduction Dementia is a progressive and debilitating disease, and people living with HIV (PLWH) often develop dementia much earlier than those not living with HIV. We estimated the incidence and prevalence of dementia and identified its key risk factors in a cohort of PLWH in British Columbia, Canada.Methods This retrospective cohort study used data from the Seek and Treat for Optimal Prevention of HIV/AIDS study. Eligible individuals were diagnosed with HIV, ≥40 years of age, naïve to antiretroviral therapy (ART), had no dementia at the index date and were followed for ≥1 year during 2002–2016. Our main outcome was incident dementia. We examined the effect of sociodemographic and clinical covariates on the incidence of dementia using a cause-specific hazard (CSH) model, with all-cause mortality as a competing risk event.Results Among 5121 eligible PLWH, 108 (2%) developed dementia. The crude 15-year prevalence of dementia was 2.1%, and the age–sex standardised incidence rate of dementia was 4.3 (95% CI: 4.2 to 4.4) per 1000 person-years. Among the adjusted covariates, CD4 cell count<50 cells/mm3 (adjusted CSH (aCSH) 8.61, 95% CI: 4.75 to 15.60), uncontrolled viremia (aCSH 1.95, 95% CI: 1.20 to 3.17), 10-year increase in age (aCSH 2.41, 95% CI: 1.89 to 3.07), schizophrenia (aCSH 2.85, 95% CI: 1.69 to 4.80), traumatic brain injury (aCSH 2.43, 95% CI: 1.59 to 3.71), delirium (aCSH 2.27, 95% CI: 1.45 to 3.55), substance use disorder (SUD) (aCSH 1.94, 95% CI: 1.18 to 3.21) and mood/anxiety disorders (aCSH 1.80, 95% CI: 1.13 to 2.86) were associated with an increased hazard for dementia. Initiating ART in 2005–2010 (versus<2000) produced an aCSH of 0.51 (95% CI: 0.30 to 0.89).Conclusions We demonstrated the negative role of immunosuppression and inflammation on the incidence of dementia among PLWH. Our study also calls for the enhanced integration of care services provided for HIV, mental health, SUD and other risk-inducing comorbidities as a means of lowering the risk of dementia within this population. |
| format | Article |
| id | doaj-art-ea2ce32dd1c74d28915dfb8b5ddf26fa |
| institution | Kabale University |
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| language | English |
| publishDate | 2024-04-01 |
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| spelling | doaj-art-ea2ce32dd1c74d28915dfb8b5ddf26fa2025-01-29T04:55:09ZengBMJ Publishing GroupBMJ Public Health2753-42942024-04-012110.1136/bmjph-2023-000627Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort studyRolando Barrios0Julio S G Montaner1Silvia Guillemi2Ni Gusti Ayu Nanditha3Viviane D Lima4Thomas L Patterson5Fidel Vila-Rodriguez6William G Honer7Jason Trigg8Hasan Nathani9Sara Shayegi-Nik10Weijia Yin11Alejandra Fonseca12Bronhilda T Takeh13British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaDepartment of Psychiatry, University of California San Diego, La Jolla, California, USADepartment of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada7 Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaIntroduction Dementia is a progressive and debilitating disease, and people living with HIV (PLWH) often develop dementia much earlier than those not living with HIV. We estimated the incidence and prevalence of dementia and identified its key risk factors in a cohort of PLWH in British Columbia, Canada.Methods This retrospective cohort study used data from the Seek and Treat for Optimal Prevention of HIV/AIDS study. Eligible individuals were diagnosed with HIV, ≥40 years of age, naïve to antiretroviral therapy (ART), had no dementia at the index date and were followed for ≥1 year during 2002–2016. Our main outcome was incident dementia. We examined the effect of sociodemographic and clinical covariates on the incidence of dementia using a cause-specific hazard (CSH) model, with all-cause mortality as a competing risk event.Results Among 5121 eligible PLWH, 108 (2%) developed dementia. The crude 15-year prevalence of dementia was 2.1%, and the age–sex standardised incidence rate of dementia was 4.3 (95% CI: 4.2 to 4.4) per 1000 person-years. Among the adjusted covariates, CD4 cell count<50 cells/mm3 (adjusted CSH (aCSH) 8.61, 95% CI: 4.75 to 15.60), uncontrolled viremia (aCSH 1.95, 95% CI: 1.20 to 3.17), 10-year increase in age (aCSH 2.41, 95% CI: 1.89 to 3.07), schizophrenia (aCSH 2.85, 95% CI: 1.69 to 4.80), traumatic brain injury (aCSH 2.43, 95% CI: 1.59 to 3.71), delirium (aCSH 2.27, 95% CI: 1.45 to 3.55), substance use disorder (SUD) (aCSH 1.94, 95% CI: 1.18 to 3.21) and mood/anxiety disorders (aCSH 1.80, 95% CI: 1.13 to 2.86) were associated with an increased hazard for dementia. Initiating ART in 2005–2010 (versus<2000) produced an aCSH of 0.51 (95% CI: 0.30 to 0.89).Conclusions We demonstrated the negative role of immunosuppression and inflammation on the incidence of dementia among PLWH. Our study also calls for the enhanced integration of care services provided for HIV, mental health, SUD and other risk-inducing comorbidities as a means of lowering the risk of dementia within this population.https://bmjpublichealth.bmj.com/content/2/1/e000627.full |
| spellingShingle | Rolando Barrios Julio S G Montaner Silvia Guillemi Ni Gusti Ayu Nanditha Viviane D Lima Thomas L Patterson Fidel Vila-Rodriguez William G Honer Jason Trigg Hasan Nathani Sara Shayegi-Nik Weijia Yin Alejandra Fonseca Bronhilda T Takeh Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort study BMJ Public Health |
| title | Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort study |
| title_full | Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort study |
| title_fullStr | Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort study |
| title_full_unstemmed | Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort study |
| title_short | Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort study |
| title_sort | incidence and contributing factors of dementia among people living with hiv in british columbia canada from 2002 to 2016 a retrospective cohort study |
| url | https://bmjpublichealth.bmj.com/content/2/1/e000627.full |
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