Possible Link Found Between HIV and Early-Onset Alzheimer Disease

A poster presented at this year’s annual meeting of the American Neurological Association demonstrates a likely greater risk of early-onset Alzheimer disease (AD) among persons living with HIV, especially if they were not on antiretroviral therapy (ART).

According to the results, just over 44% of aging HIV patients have low adherence to their ART, which the authors termed a “disturbing problem.”

They wanted “to assess the risk of early-onset AD among HIV patients aged 64 or younger, with/without evidence of adhering to an active HIV antiretroviral therapy,” because HIV-positive individuals are living longer. As a result of viral load control, they are more often dying from non–HIV-related causes, one of which is AD.

Using data from MarketScan Commercial Claims and Encounters (CCE), the authors evaluated employee and dependent health care claims at more than 250 medium and large employers for 2005 through 2014. Eligible participants had to have at least 1 year of enrollment in CCE and be aged 50 or older.

Analysis found:

• A greater prevalence of early-onset AD in persons with HIV vs HIV-negative individuals: 0.11% vs 0.07%, respectively
• A high prevalence of early-onset AD in persons with HIV not on ART: 0.16%
• A similar prevalence of early-onset AD in patients on ART (n = 41,242) and individuals who did not have HIV/the general population (n = 32,902): 0.07%
• Lower risk of AD when on ART: adjusted odds ratio (aOR), 0.50 (95% CI, 0.30-0.81; P = .005)

Multivariable logistic regression also found that these factors indicated a greater risk for early-onset AD in HIV-positive individuals:

• Each year of older age: aOR, 1.02 (95% CI, 0.98-1.07; P = .290)
• Being male vs female: aOR, 1.35 (95% CI, 0.82-2.23; P = .238)
• Living in an urban vs rural area: aOR, 1.59 (95% CI, 0.50-5.01; P = .355)
• Having health coverage through a health maintenance organization: aOR, 1.42 (95% CI, 0.79-2.56; P = .238)
• Having the following comorbid conditions:
  • Diabetes: aOR, 1.37 (95% CI, 0.71-2.64; P = .354)
  • Hypertension: aOR, 2.06 (95% CI, 1.27-3.33; P = .001)
  • Heart disease: aOR, 2.47 (95% CI, 1.44-4.23; P = .003)

The mean (SD) ages were similar overall and for the group on ART: 52.4 (5.0) and 52.0 (5.1) years, respectively. Most were male (80.2% overall, 59.2% of the ART group), from the South (41.8% overall) or West (64.2% of the ART group), and lived in an urban setting (93.9% and 55.7%, respectively). The most common comorbid condition was hypertension.

All diagnoses were confirmed with International Classification of Diseases, Ninth Revision codes for HIV, AD, and other comorbid medical conditions.

“HIV without ART treatments in associated with increased risk for early onset Alzheimer’s disease,” the authors concluded. “ART is associated with significantly reduced AD risk.”

Reference

Liu G, Kong L, Ba D, Zhao C. Associations between HIV, antiretroviral therapy and risk of early onset Alzheimer’s disease. Presented at: ANA2020; October 4-9, 2020. https://uploads.ana2020virtuallive.org/files/2e97e1b5-1a91-4fab-97b9-94d2a60435dd/Posters/31de6468-7852-47e6-bc99-e288418a9b29.pdf