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Neurol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> With widespread use of antiretroviral medications, people living with HIV (PWH) are living longer worldwide, increasing their risk of developing neurocognitive impairment (NCI). The proportion of Peruvians over age 60 is expected to increase to 25% of the population by 2050, including PWH. Therefore, the problem of aging and NCI, especially in the setting of HIV infection, is uniquely pressing. We sought to study the rates of and risk factors associated with NCI among middle-aged and older PWH in Lima, Peru.<\/jats:p><jats:p><jats:bold>Materials and Methods:<\/jats:bold> Sociodemographic, medical (infectious and non-infectious), and psychiatric comorbidity and laboratory data were collected. We administered a brief neuropsychological battery evaluating seven cognitive domains affected in HIV-associated NCI and a depression screening. Cognitive test raw scores were converted to <jats:italic>T<\/jats:italic>-scores that were demographically adjusted. Descriptive statistics were performed together with regression (unadjusted and adjusted) analyses to determine potential risk factors for NCI among PWH.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> This was a cross-sectional study in which 144 PWH aged \u226540 years attending a large HIV clinic in Lima, Peru, were recruited from September 2019 to March 2020. Mean age was 51.6 \u00b1 7.7 years, and mean years of education were 14.0 \u00b1 3.1 with 15% females. Median [interquartile range (IQR)] current CD4 and nadir CD4 were 554 (371, 723) and 179 (83, 291), respectively, and 10% currently had AIDS. The prevalence of NCI was 28.5%, and many demonstrated difficulty with attention and working memory (70%). One-quarter of PWH had mild depression or worse on Patient Health Questionnaire 9 (PHQ-9 \u2265 5). In bivariate analyses, neither a depression history nor a higher PHQ-9 score correlated with NCI. No other non-communicable medical or psychiatric comorbidity nor HIV characteristic was predictive of NCI. Having a positive lifetime history of hepatitis B infection, pulmonary tuberculosis, or syphilis increased risk of NCI (PR 1.72; 95% CI 1.04\u20132.86) in unadjusted analyses, but not in adjusted analyses.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> NCI among older Peruvians with HIV was found to be highly prevalent with levels consistent with prior reports of HIV-associated NCI worldwide. Common latent HIV-associated co-infections, including latent syphilis, hepatitis B infection, or pulmonary tuberculosis, may increase the risk of NCI among middle-aged and older PWH in Peru.<\/jats:p>","DOI":"10.3389\/fneur.2021.629257","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T10:10:51Z","timestamp":1623924651000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Characterization of HIV-Associated Neurocognitive Impairment in Middle-Aged and Older Persons With HIV in Lima, Peru"],"prefix":"10.3389","volume":"12","author":[{"given":"Monica M.","family":"Diaz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcela Gil","family":"Zacar\u00edas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Sotolongo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda F.","family":"Sanes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald J.","family":"Franklin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda J.","family":"Marquine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Cherner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar","family":"C\u00e1rcamo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald J.","family":"Ellis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serggio","family":"Lanata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia J.","family":"Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"221","DOI":"10.3389\/fnagi.2017.00221","article-title":"Dementia in latin america: epidemiological evidence and implications for public policy","volume":"9","author":"Custodio","year":"2017","journal-title":"Front Aging Neurosci."},{"key":"B2","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1016\/j.bjid.2012.11.007","article-title":"Aging with HIV: a practical review","volume":"17","author":"Cardoso","year":"2013","journal-title":"Braz J InfectDis."},{"key":"B3","unstructured":"ReliefWebHIV and Aging - A Special Supplement to the UNAIDS Report on the Global AIDS Epidemic 2013 - World2013"},{"key":"B4","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/1471-2318-10-53","article-title":"The contribution of chronic diseases to the prevalence of dependence among older people in Latin America, China and India: a 10\/66 dementia research group population-based survey","volume":"10","author":"Sousa","year":"2010","journal-title":"BMC Geriatrics."},{"key":"B5","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1007\/s13365-015-0366-7","article-title":"Elevated rates of mild cognitive impairment in HIV disease","volume":"21","author":"Sheppard","year":"2015","journal-title":"J Neurovirol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s13365-010-0006-1","article-title":"HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors","volume":"17","author":"Heaton","year":"2011","journal-title":"J Neurovirol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2087","DOI":"10.1212\/WNL.0b013e318200d727","article-title":"HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER study","volume":"75","author":"Heaton","year":"2010","journal-title":"Neurology."},{"key":"B8","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1017\/S1355617717001102","article-title":"HIV-associated neurocognitive disorders: a global perspective","volume":"23","author":"Saloner","year":"2017","journal-title":"J Int Neuropsychol Soc."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1212\/01.WNL.0000287431.88658.8b","article-title":"Updated research nosology for HIV-associated neurocognitive disorders","volume":"69","author":"Antinori","year":"2007","journal-title":"Neurology."},{"key":"B10","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1001\/archneur.1997.00550160054016","article-title":"Neurocognitive impairment is an independent risk factor for death in HIV infection. 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