Abstract Details

Title Cognitive Concerns are a Risk Factor for Mortality in People with Human Immunodeficiency Virus and COVID-19

Topic Infectious Disease

Presentation(s) S21 - Acute and Post-Acute Sequelae of COVID-19 (3:54 PM-4:06 PM)

Poster/Presentation
Number 003

Background

Despite higher prevalence of cognitive disorders in PWH and dementia being a risk factor for COVID-19 mortality, the association between cognitive impairment and adverse outcomes in PWH with COVID-19 has not been well established.

Objective To assess the contribution of cognitive symptoms to risk of mortality from COVID-19 in people with HIV (PWH).

Design/Methods Matched case-control study (1:10) of PWH and without (PWoH) with documented SARS-CoV-2 PCR positivity from March 2020-March 2021 evaluated at a Boston-based healthcare system. Data were extracted from the electronic health record. Matching was on age, sex, race, and zip code. Primary exposures were dementia (ICD-10 code) and cognitive concerns (concern for impairment within 12 months pre-COVID-19, ascertained using a semi-automated chart annotation tool). VACS2.0 Index (including general and HIV-specific biomarkers) was calculated. VACS2.0 Index-adjusted logistic regression models assessed effect of dementia and cognitive concerns on odds of death (OR[95% confidence interval]).

Results Among 14,129 patients with COVID-19, 64 PWH were identified and matched to 463 PWoH. Among PWH, 89% were on antiretroviral therapy, 87% had an HIV-1 viral load <200 copies/mL, and 19% had CD4 <200 cells/μL. VACS2.0 score predicted level of care and mortality in both PWH and PWoH. PWH had higher prevalence of dementia (16% vs. 6%,p=0.01) and cognitive concerns (22% vs. 16%,p=0.04). Death was more frequent in PWH (17% vs. 6%,p<0.01), at younger ages (58 vs. 66 years,p=0.03). VACS2.0-adjusted regression models found cognitive concerns (2.4[1.1-5.3],p=0.03) and dementia (2.4[1.0-5.8],p=0.05) significantly associated with odds of death in the overall group. Among PWH only, aOR for cognitive concern approached significance (3.9[0.81-20.19],p=0.09), while dementia (1.75[0.29-8.71],p=0.50) did not.

Conclusions

Dementia and cognitive concerns were associated with mortality among people with COVID-19, and the magnitude of the effect of cognitive impairment may be greater in PWH. Assessment of cognitive status is an important component to care for PWH in the COVID-19 era.

Authors/Disclosures
Emily A. Rudmann (Mass General Hospital) PRESENTER	Ms. Rudmann has nothing to disclose.
Douglas R. Wilcox, MD, PhD (Massachusetts General Hospital)	Dr. Wilcox has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Haitham Alabsi, DO (Massachusetts General Hospital, Brigham, Harvard)	Dr. Alabsi has received personal compensation for serving as an employee of Biogen.
	No disclosure on file
	No disclosure on file
M. B. Westover, MD, PhD (MGH)	Dr. Westover has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Beacon Biosignals. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities.
Sudeshna Das (MGH)	No disclosure on file
Shibani S. Mukerji, MD, PhD (Massachusetts General Hospital)	Dr. Mukerji has stock in Gilead Science. The institution of Dr. Mukerji has received research support from NIH. The institution of Dr. Mukerji has received research support from Massachusetts General Hospital.