Anemia and Erythrocyte Indices are Associated with Neurocognitive Performance Across Multiple Ability Domains in Adults with HIV
AUTHORS
- PMID: 36580636 [PubMed].
ABSTRACT
BACKGROUND: Anemia is linked to neurocognitive impairment (NCI) in people with HIV (PWH), but its impact within specific ability domains, and in ssdiverse populations with HIV, is uncertain.
METHODS: Participants included 1,339 PWH enrolled in observational HIV cohort studies with a mean of 3 comprehensive neurocognitive assessments over 30 months. Global and domain-specific neurocognitive function were assessed by the Global and Domain Deficit Score (GDS and DDS, respectively), or as GDS- or DDS-defined NCI (GDS≥0.5, DDS>0.5). Time-dependent associations of anemia or red-cell indices with neurocognitive function were evaluated by multivariable regression.
RESULTS: Mean age at entry was 43.6 years (85% male, 23.9% Hispanic, 16.7% African-ancestry by self-report, 69.8% virally suppressed). Anemia occurred at entry in 297 (22.2%) and developed subsequently in another 129 (9.6%). Anemia (present in 26.8% of cognitively impaired PWH at entry) and lower hemoglobin were associated with higher (worse) GDS values; the association for anemia persisted after multivariable adjustment and in virally suppressed persons (p<0.0001). Anemia was also associated with reduced processing speed, motor function, learning, delayed recall, working memory (all p<0.01), executive function (p=0.021), and verbal fluency (p=0.035), and these findings persisted in longitudinal analyses (adjusted p<0.01 for all domains, except verbal fluency). Higher mean corpuscular volume and mean corpuscular hemoglobin were associated with less impairment in learning and recall (all p<0.05).
CONCLUSIONS: Anemia in diverse and virally suppressed PWH associates with reduced neurocognitive performance in multiple domains, cross-sectionally and over time. The impact of identifying and treating anemia to prevent or slow neurocognitive decline in PWH should be prospectively evaluated.