The Impact of Human Immunodeficiency Virus (HIV) on Dementia Risk in Medicare Beneficiaries (4845)

Objective: To compare dementia risk between Medicare beneficiaries (≥65 years of age) with and without HIV.

Background: With improvements in anti-retroviral therapies, life expectancy of persons living with HIV (PLWH) is increasing. Treatment-related viral suppression may protect neurocognitive health; however, the long-term impact of HIV on dementia risk remains unknown.

Design/Methods: Using the Chronic Conditions Warehouse files, we conducted a retrospective cohort study of eligible Medicare beneficiaries (part A and B coverage) with and without HIV at baseline. During follow-up for incident dementia (2012–2017), beneficiaries were censored on death or loss of eligibility. Beneficiaries diagnosed with dementia prior to 2012 were excluded from incident analysis. Covariates included sociodemographic characteristics, comorbid medical conditions, neuropsychiatric diagnoses, and healthcare utilization. Bivariate analysis was used to compare those with and without HIV. HIV-positive and negative individuals were 1:4 matched on age, sex, race, and zip code. In the matched sample, crude and adjusted cox proportional hazards models assessed the association between HIV and dementia risk.

Results: Out of 26,646 PLWH who met eligibility, 23.0% (n=5,909) were excluded due to prevalent dementia; only 14.8% (3,242,281/21,950,320) of eligible, HIV negative individuals were excluded due to prevalent dementia. For the incident analysis, after matching, there were 19,103 PLWH and 73,004 without; PLWH were more likely to be dual eligible, originally eligible due to disability, have more comorbidities, and higher healthcare utilization (standardized differences ≥0.10). PLWH had a dementia incidence rate of 41.9/1,000 person years, as opposed to non-HIV persons (30.7/1000 person years). PLWH were more likely to be diagnosed with dementia (hazard ratio [HR]=1.39, 95% CI: 1.34, 1.44; adjusted HR=1.14, 95% CI: 1.10, 1.19).

Conclusions: There appears to be a long-term impact of HIV on development of dementia. Future studies should examine the mechanism behind this finding as well as explore possible preventive measures.

Disclosure: An immediate family member of Sarah Banwell has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. An immediate family member of Sarah Banwell has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. The institution of an immediate family member of Sarah Banwell has received research support from National MS Society. The institution of an immediate family member of Sarah Banwell has received research support from National Institute of health. An immediate family member of Sarah Banwell has a non-compensated relationship as a Board of Directors with AAN that is relevant to AAN interests or activities. Danielle Abraham has received research support from The National Institute of Neurological Disorders and Stroke. Danielle Abraham has received personal compensation in the range of $5,000-$9,999 for serving as a freelance writer with The Parkinson’s Foundation. Dr. Wright Willis has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Pharmacoepidemiology and Drug Safety. The institution of Dr. Wright Willis has received research support from NIH. The institution of Dr. Wright Willis has received research support from NIA. The institution of Dr. Wright Willis has received research support from Biogen. The institution of Dr. Wright Willis has received research support from Parkinson Foundation. The institution of Dr. Wright Willis has received research support from Arcadia.