JMIR Publications

ABSTRACT

Background:

Neurocognitive impairment are prevalent among older people in China. It is more problematic among older people living with HIV (PLWH).

Objective:

This study was to compare neurocognitive performance between older PLWH and HIV-negative controls, and to explore whether the association between HIV status and neurocognitive performance was mediated by depressive symptoms and/or level of physical activity.

Methods:

A cross-sectional study was conducted in Yongzhou, China. All PLWH aged ≥50 years listed in the registry were invited. Frequency matching was used to sample HIV-negative controls from general population according to the distribution of age, sex, and years of formal education of older PLWH. A total of 315 older PLWH and 350 HIV-negative controls completed the face-to-face interview and comprehensive neuropsychological assessment of seven domains (learning, memory, working memory, verbal fluency, processing speed, executive function and motor skills).

Results:

As compared to HIV-negative controls, older PLWH performed worse in global score and all seven domains (P<.05). HIV infection was associated with higher depressive symptoms (P<.001) and lower level of physical activity (P<.001). Depressive symptoms and physical activity were negatively correlated (P<.001). Depressive symptoms and/or level of physical activity mediated the association between HIV status and global z score and four domain z scores of neurocognitive performance (learning, memory, verbal fluency, and processing speed).

Conclusions:

Change in mental health and physical activity after HIV infection may partially explain why older PLWH are more susceptible to neurocognitive impairment. Promoting mental health and physical activity are potential entry points to slow down the progress of neurocognitive impairment among older PLWH.