Original Article

Sociodemographic Characteristics of HIV-Associated Dementia in the South Carolina Alzheimer’s Disease Registry

Authors: Monique J. Brown, PhD, MPH, FGSA, Margaret C. Miller, PhD, Omar Bagasra, MD, PhD, Lucy A. Ingram, PhD


Objectives: Studies examining the sociodemographic characteristics associated with human immunodeficiency virus (HIV)–associated dementia (HAD) are lacking, especially in the southern United States. The aim of this study was to describe the characteristics of HAD using South Carolina Alzheimer’s Disease Registry data, and examine these characteristics across two time periods.

Methods: Data were obtained from the population-based, South Carolina Alzheimer’s Disease Registry from 2000–2006 and 2010–2016 (N = 165,487). Crude and multivariable logistic regression models were applied to determine sociodemographic characteristics associated with HAD by time period.

Results: Younger, Black, Other, men, and urban populations had greater odds of being diagnosed as having HAD in both time periods. For example, compared with individuals aged 85 years and older, individuals aged 18 to 34 had 97 times the odds (adjusted odds ratio 97.0; 95% confidence interval 31.6–297.8) of being diagnosed as having HAD. In 2010–2016, however, nursing facility populations had a greater odds of being diagnosed as having HAD.

Conclusions: We found that younger populations (younger than 74 years), communities of color, men, urban populations, and nursing facility populations were more likely to have HAD. Future research should focus on the association between HAD and risk for Alzheimer’s disease.
Posted in: Infectious Disease133 Acquired Immunodeficiency Syndrome (AIDS) And Human Immunodeficiency Virus (HIV) Infection17

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1. Kopstein M, Mohlman DJ. HIV-1 encephalopathy and AIDS dementia complex. https://www.ncbi.nlm.nih.gov/books/NBK507700/. Published 2021. Accessed July 18, 2023.
2. Sharma I. Interrogating the impact of combination antiretroviral therapies on HIV-associated neurocognitive disorders. HIV Med 2021;22:783–790.
3. Ghafouri M, Amini S, Khalili K, et al. HIV-1 associated dementia: symptoms and causes. Retrovirology 2006;3:28.
4. Johns Hopkins Medicine. HIVand dementia. https://www.hopkinsmedicine.org/health/conditions-and-diseases/hiv-and-aids/hiv-and-dementia. Published 2021. Accessed August 3, 2021.
5. Gandhi NS, Skolasky RL, Peters KB, et al. A comparison of performance-based measures of function in HIV-associated neurocognitive disorders. J Neurovirol 2011;17:159–165.
6. Ances BM, Clifford DB. HIV-associated neurocognitive disorders and the impact of combination antiretroviral therapies. Curr Neurol Neurosci Rep 2008;8:455–461.
7. Rumbaugh JA, Tyor W. HIV-associated neurocognitive disorders: five new things. Neurol Clin Pract 2015;5:224–231.
8. Kamal S, Locatelli I, Wandeler G, et al. The presence of human immunodeficiency virus-associated neurocognitive disorders is associated with a lower adherence to combined antiretroviral treatment. Open Forum Infect Dis 2017;4:ofx070.
9. Centers for Disease Control and Prevention. HIV treatment as prevention. https://www.cdc.gov/hiv/risk/art/index.html Published 2021. Accessed August 3, 2021.
10. Hall WD, Ferrario CM, Moore MA, et al. Hypertension-related morbidity and mortality in the southeastern United States. Am J Med Sci 1997;313: 195–209.
11. Hirai AH, Sappenfield WM, Kogan MD, et al. Contributors to excess infant mortality in the U.S. South. Am J Prev Med 2014;46:219–227.
12. Centers for Disease Control and Prevention. HIV in the southern United States. https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf. Published 2018. Accessed May 31, 2019.
13. Centers for Disease Control and Prevention. HIV surveillance report: diagnoses of HIV infection in the United States and dependent areas, 2019. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-32.pdf. Published 2019. Accessed August 3, 2021.
14. Centers for Disease Control and Prevention. Health disparities in HIV/AIDS, viral hepatitis, STDs, and TB: defining health disparities. https://www.cdc.gov/nchhstp/healthdisparities/default.htm. Published 2020. Accessed August 4, 2021.
15. Hall HI, Li J, McKenna MT. HIV in predominantly rural areas of the United States. J Rural Health 2005;21:245–253.
16. Williams C, Eisenberg M, Becher J, et al. Racial disparities in HIV prevalence and risk behaviors among injection drug users and members of their risk networks. J Acquir Immune Defic Syndr 2013;63(suppl 1):S90–S94.
17. Centers for Disease Control and Prevention. HIV: HIV and men. https://www.cdc.gov/hiv/group/gender/men/index.html. Published 2020. Accessed August 4, 2021.
18. Denning PD, E. Communities in crisis: is there a generalized HIV epidemic in impoverished urban areas of the United States? https://www.cdc.gov/hiv/group/poverty.html. Published 2019. Accessed August 4, 2021.
19. Centers for Disease Control and Prevention. HIV: HIV and African American people. https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html. Published 2021. Accessed August 4, 2021.
20. South Carolina Department of Health and Environmental Control. South Carolina epidemiologic profile of HIV, AIDS, and sexually transmitted infections 2020. https://scdhec.gov/sites/default/files/media/document/SC-HIV-Epi-Profile-2020.pdf. Published 2020. Accessed August 4, 2021.
21. Weissman S, Duffus WA, Iyer M, et al. Rural-urban differences in HIV viral loads and progression to AIDS among new HIV cases. South Med J 2015; 108:180–188.
22. Office for the Study of Aging, Arnold School of Public Health. 2021 Annual Report South Carolina Alzheimer’s Disease Registry. https://sc.edu/study/colleges_schools/public_health/documents/alzheimers_registry_report.pdf. Published 2022. Accessed July 27, 2023.
23. Force G, Ghout I, Ropers J, et al. Improvement of HIV-associated neurocognitive disorders after antiretroviral therapy intensification: the Neuro+3 study. J Antimicrob Chemother 2021;76:743–752.
24. Janssen RS. Epidemiology of human immunodeficiency virus infection and the neurologic complications of the infection. Semin Neurol 1992; 12:10–17.
25. McArthur JC, Sacktor N, Selnes O. Human immunodeficiency virus-associated dementia. Semin Neurol 1999;19:129–150.
26. Diaz MM, Zacarías MG, Sotolongo P, et al. Characterization of HIV-associated neurocognitive impairment in middle-aged and older persons with HIV in Lima, Peru. Front Neurol 2021;12:629257.
27. Flatt A, Gentry T, Kellett-Wright J, et al. Prevalence and 1-year incidence of HIV-associated neurocognitive disorder (HAND) in adults aged ≥50 years attending standard HIV clinical care in Kilimanjaro, Tanzania. Int Psychogeriatr 2023;35:339–350.
28. Casale M, Carlqvist A, Cluver L. Recent interventions to improve retention in HIV care and adherence to antiretroviral treatment among adolescents and youth: a systematic review. AIDS Patient Care STDs 2019;33:237–252.
29. Córdova D, Mendoza Lua F, Ovadje L, et al. Randomized controlled trials of technology-based HIV/STI and drug abuse preventive interventions for African American and Hispanic youth: systematic review. JMIR Public Health Surveill 2017;3:e96.
30. Ibitoye M, Lappen H, Freeman R, et al. Technology-based interventions to increase point-of-care HIV testing and linkage to care among youth in the US: a systematic review. AIDS Behav 2021;25:1829–1838.
31. Bhochhibhoya A, Harrison S, Yonce S, et al. A systematic review of psychosocial interventions for older adults living with HIV. AIDS Care 2021;33:971–982.
32. Negin J, Rozea A, Martiniuk AL. HIV behavioural interventions targeted towards older adults: a systematic review. BMC Public Health 2014;14:507.
33. Centers for Disease Control and Prevention HIV: HIV by Age: HIV Diagnoses. https://www.cdc.gov/hiv/group/age/diagnoses.html. Published 2022. Accessed July 27, 2023.
34. Centers for Disease Control and Prevention. HIV and older Americans. https://www.cdc.gov/hiv/group/age/olderamericans/index.html. Published 2020. Accessed January 6, 2021.
35. Li W, Galey D, Mattson MP, et al. Molecular and cellular mechanisms of neuronal cell death in HIV dementia. Neurotox Res 2005;8:119–134.
36. Canet G, Dias C, Gabelle A, et al. HIV neuroinfection and Alzheimer's disease: similarities and potential links? Front Cell Neurosci 2018;12:307.
37. Brew BJ, Pemberton L, Blennow K, et al. CSF amyloid beta42 and tau levels correlate with AIDS dementia complex. Neurology 2005;65:1490–1492.
38. Esiri MM, Biddolph SC, Morris CS. Prevalence of Alzheimer plaques in AIDS. J Neurol Neurosurg Psychiatry 1998;65:29–33.
39. Green DA, Masliah E, Vinters HV, et al. Brain deposition of beta-amyloid is a common pathologic feature in HIV positive patients. AIDS 2005;19: 407–411.
40. Lannuzel A, Barnier JV, Hery C, et al. Human immunodeficiency virus type 1 and its coat protein gp120 induce apoptosis and activate JNK and ERK mitogen-activated protein kinases in human neurons. Ann Neurol 1997;42: 847–856.
41. Yarza R, Vela S, Solas M, et al. c-Jun N-terminal kinase (JNK) signaling as a therapeutic target for Alzheimer's disease. Front Pharmacol 2015;6:321.
42. Ferrarese C, Aliprandi A, Tremolizzo L, et al. Increased glutamate in CSF and plasma of patients with HIV dementia. Neurology 2001;57: 671–675.
43. Milanini B, Valcour V. Differentiating HIV-associated neurocognitive disorders from Alzheimer's disease: an emerging issue in geriatric neuroHIV. Curr HIV/ AIDS Rep 2017;14:123–132.
44. Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology 2007;69:1789–1799.
45. Silva AC, Rodrigues BS, Micheletti AM, et al. Neuropathology of AIDS: an autopsy review of 284 cases from Brazil comparing the findings pre- and post-HAART (highly active antiretroviral therapy) and pre- and postmortem correlation. AIDS Res Treat 2012;2012:186850.