Identifying intervention opportunities in the continuum of cognitive impairment among persons aging with HIV

PROJECT SUMMARY / ABSTRACT
Specific Aims: This proposal aims to identify opportunities to improve the prevention and mitigation of risks
associated with cognitive impairment among people aging with HIV. Aim 1 will estimate the proportion of
cognitive impairment cases potentially attributable to psychosocial and behavioral risk factors to prioritize
those, which if intervened upon, could hypothetically result in the greatest prevention of cognitive impairment.
Aim 2 will determine whether cognitive impairment increases the risk of losing one’s durable (sustained) viral
suppression so we may mitigate this adverse outcome.
Significance: As people with HIV (PWH) live longer due to treatment advances, they face a growing burden of
age-related conditions, including cognitive impairment. PWH experience higher rates of cognitive impairment
than people without HIV despite widespread viral suppression, which implicates non-HIV-related factors in their
cognitive risk. Focusing on psychosocial and behavioral risk factors, which are prevalent in PWH and causally
linked to cognitive impairment, can help to prioritize fruitful prevention strategies. In addition, cognitive
impairment may threaten the durability of viral suppression, which could hinder cognitive maintenance and
prevention of HIV transmission. Considering these issues in tandem can inform preparations for the long-term
healthcare needs of people aging with HIV.
Approach: These aims will leverage the Multicenter AIDS Cohort Study (MACS) (Aim 1), which includes 10
years of longitudinal cognitive screening data, and the Johns Hopkins HIV Clinical Cohort (JHHCC) (Aim 2), an
urban cohort of PWH with rich clinical data. In Aim 1, we will estimate population attributable fractions for
incident cognitive impairment, using longitudinal data and methods to account for time-varying risk factors,
censoring, and competing risks. In Aim 2, we will employ a longitudinal closed cohort design to estimate the
risk ratio for loss of durable viral suppression in PWH by cognitive impairment status.
Training Information: The proposed research encompasses the dissertation of Madeline Brooks, a PhD
student in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. The
training plan consists of coursework, mentorship, and professional development to support the successful
completion of these aims and prepare Ms. Brooks to become an independent research epidemiologist. These
aims address priorities of the NIH Office of AIDS Research to address the role of non-infectious comorbidities
in central nervous system complications and subsequent implications for HIV transmission.

Grant Number: 1F31MH142332-01
NIH Institute/Center: NIH
Principal Investigator: Madeline Brooks