AIDS (London, England) · 2025
Longitudinal effects of polypharmacy on cognitive function in people with HIV.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Korpela Eero, Dastgheyb Raha M, Letendre Scott L, Franklin Donald R, Ma Qing, Rubin Leah H, Xu Yanxun
Аннотация
OBJECTIVE: To investigate the relationship of polypharmacy exposure to longitudinal trajectories of global and domain-specific cognitive function in people with HIV (PWH), focusing on the effects of both stable and transitioning polypharmacy regimens.
DESIGN: Longitudinal analyses.
METHODS: Longitudinal data from 2173 PWH, including 1017 virally suppressed (VS-PWH), were analyzed using harmonized datasets from the CHARTER, NNTC, and HNRP studies. Polypharmacy was categorized as low (0-4 medications), moderate (5-9), or high (≥10) based on the number of nonantiretroviral therapy (non-ART) medications. Demographically adjusted global and domain-specific T-scores were derived from standardized batteries. To assess the association between polypharmacy and cognitive trajectories, we developed a novel transition-based mixed-effects regression approach that captured both stable and changing patterns of polypharmacy exposure over time, allowing for the assessment of immediate and cumulative cognitive effects of medication burden.
RESULTS: Higher polypharmacy levels were significantly associated with poorer global and domain-specific cognitive function. Participants with high polypharmacy exhibited steeper cognitive declines, while those with low polypharmacy demonstrated stable or modestly improved trajectories. This pattern was similarly observed in VS-PWH. Transitions from low to high polypharmacy resulted in significant global and domain-specific cognitive declines. Conversely, reductions from moderate or high to lower polypharmacy levels yielded cognitive improvements - particularly in motor function - in both PWH and VS-PWH populations.
CONCLUSION: Polypharmacy imposes a cumulative burden on cognitive function in both PWH and VS-PWH. Higher polypharmacy levels exacerbate cognitive decline, highlighting the necessity of targeted strategies to manage polypharmacy and mitigate its long-term cognitive impact.
DESIGN: Longitudinal analyses.
METHODS: Longitudinal data from 2173 PWH, including 1017 virally suppressed (VS-PWH), were analyzed using harmonized datasets from the CHARTER, NNTC, and HNRP studies. Polypharmacy was categorized as low (0-4 medications), moderate (5-9), or high (≥10) based on the number of nonantiretroviral therapy (non-ART) medications. Demographically adjusted global and domain-specific T-scores were derived from standardized batteries. To assess the association between polypharmacy and cognitive trajectories, we developed a novel transition-based mixed-effects regression approach that captured both stable and changing patterns of polypharmacy exposure over time, allowing for the assessment of immediate and cumulative cognitive effects of medication burden.
RESULTS: Higher polypharmacy levels were significantly associated with poorer global and domain-specific cognitive function. Participants with high polypharmacy exhibited steeper cognitive declines, while those with low polypharmacy demonstrated stable or modestly improved trajectories. This pattern was similarly observed in VS-PWH. Transitions from low to high polypharmacy resulted in significant global and domain-specific cognitive declines. Conversely, reductions from moderate or high to lower polypharmacy levels yielded cognitive improvements - particularly in motor function - in both PWH and VS-PWH populations.
CONCLUSION: Polypharmacy imposes a cumulative burden on cognitive function in both PWH and VS-PWH. Higher polypharmacy levels exacerbate cognitive decline, highlighting the necessity of targeted strategies to manage polypharmacy and mitigate its long-term cognitive impact.