Anticholinergic and Sedative Medications Are Associated With Neurocognitive Performance of Well Treated People With Human Immunodeficiency Virus

Bernadette Jakeman; Alexandra U Scherrer; Katharine E A Darling; Jose Damas; Melanie Bieler-Aeschlimann; Barbara Hasse; Ladina Schlosser; Anna Hachfeld; Klemens Gutbrod; Philip E Tarr; Alexandra Calmy; Frederic Assal; Ursula Kunze; Marcel Stoeckle; Patrick Schmid; Gianina Toller; Stefania Rossi; Caroline di Benedetto; Renaud du Pasquier; Matthias Cavassini; Catia Marzolini; NAMACO Study Group, a Swiss HIV Cohort Study

doi:10.1093/ofid/ofac457

Anticholinergic and Sedative Medications Are Associated With Neurocognitive Performance of Well Treated People With Human Immunodeficiency Virus

Open Forum Infect Dis. 2022 Sep 2;9(9):ofac457. doi: 10.1093/ofid/ofac457. eCollection 2022 Sep.

Authors

Bernadette Jakeman^{1

2

3}, Alexandra U Scherrer^{4

5}, Katharine E A Darling⁶, Jose Damas⁶, Melanie Bieler-Aeschlimann⁷, Barbara Hasse⁴, Ladina Schlosser⁸, Anna Hachfeld⁹, Klemens Gutbrod¹⁰, Philip E Tarr¹¹, Alexandra Calmy¹², Frederic Assal¹³, Ursula Kunze¹⁴, Marcel Stoeckle^{2

3}, Patrick Schmid¹⁵, Gianina Toller¹⁶, Stefania Rossi¹⁷, Caroline di Benedetto¹⁸, Renaud du Pasquier⁷, Matthias Cavassini⁶, Catia Marzolini^{2

3}; NAMACO Study Group, a Swiss HIV Cohort Study

Collaborators

NAMACO Study Group, a Swiss HIV Cohort Study:
Matthias Cavassini, Renaud Du Pasquier, Melanie Bieler-Aeschlimann, Isaure Nadin, Peter Brugger, Klemens Gutbrod, Andreas U Monsch, Ursi Kunze, Gianina Toller, Ladina Schlosser, Marc Schwind, Stefania Rossi, Arseny Sokolov, Frederic Assal, Tobias Derfuss, Sebastian von Arx, Gunter Eisele, Manuel Bertschi, Thomas Hundsberger, Michael Oberholzer, Illijas Jelcic, Leonardo Sacco, Renaud Du Pasquier, Alexandra Calmy, Thanh Doco Lecompte, Anna Hachfeld, Helen Kovari, Barbara Hasse, Philip Tarr, Marcel Stoeckle, Christoph Fux, Enos Bernasconi, Caroline Di Benedetto, Patrick Schmid, Katharina Darling, Matthias Cavassini, Alexandra Scherrer, Katharina Kusejko, Yannick Vallet, Valerie Sormani, Jose Damas, Bruno Ledergerber, Isabella Locatelli, Catia Marzolini, Laurent Decosterd, Cristina Granziera, Gunnar Krueger, Reto Meuli, Maria Vargas

Affiliations

¹ Department of Pharmaceutical Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, New Mexico, USA.
² Department of Medicine, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
³ Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
⁴ Departments of Medicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
⁵ Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
⁶ Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
⁷ Service of Neurology, Department of Neurosciences, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
⁸ Department of Neuropsychology, Neurology Clinic, University Hospital Zurich, Zurich, Switzerland.
⁹ Department of Infectious Diseases, University Hospital Bern, University of Bern, Bern, Switzerland.
¹⁰ Department of Neurology, University Hospital Bern, University of Bern, Neurozentrum Bern, Switzerland.
¹¹ University Department of Medicine, Kantonsspital Bruderholz, University of Basel, Basel, Switzerland.
¹² Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland.
¹³ Service of Neurology, University Hospital Geneva, University of Geneva, Geneva, Switzerland.
¹⁴ Memory Clinic, Felix Platter Hospital University Center for Medicine of Aging, Basel, Switzerland.
¹⁵ Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
¹⁶ Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
¹⁷ Neuropsychology and Speech Therapy Unit, Neurocenter of Southern Switzerland, Regional Hospital Lugano, Lugano, Switzerland.
¹⁸ Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.

Abstract

Background: We previously showed that anticholinergic (ACH) medications contribute to self-reported neurocognitive impairment (NCI) in elderly people with human immunodeficiency virus (PWH). The current cross-sectional study further evaluated the effect of ACH and sedative drugs on neurocognitive function in PWH who underwent comprehensive neuropsychological evaluation.

Methods: A medication review was performed in PWH enrolled in the prospective Neurocognitive Assessment in Metabolic and Aging Cohort within the Swiss HIV Cohort Study. Neurocognitive functions were analyzed in 5 domains (motor skills, speed of information, attention/working memory, executive functions, and verbal learning memory). The effect of ACH and sedative medications on neurocognitive functioning was evaluated using linear regression models for the continuous (mean z-score) outcome and multivariable logistic regression models for the binary (presence/absence) outcome.

Results: A total of 963 PWH (80% male, 92% Caucasian, 96% virologically suppressed, median age 52) were included. Fourteen percent of participants were prescribed ≥1 ACH medication and 9% were prescribed ≥1 sedative medication. Overall, 40% of participants had NCI. Sedative medication use was associated with impaired attention/verbal learning and ACH medication use with motor skills deficits both in the continuous (mean z-score difference -0.26 to -0.14, P < .001 and P = .06) and binary (odds ratio [OR], ≥1.67; P < .05) models. Their combined use was associated with deficits in overall neurocognitive functions in both models (mean z-score difference -0.12, P = .002 and OR = 1.54, P = .03). These associations were unchanged in a subgroup analysis of participants without depression (n = 824).

Conclusions: Anticholinergic and sedative medications contribute to NCI. Clinicians need to consider these drugs when assessing NCI in PWH.

Keywords: HIV; anticholinergic medication; neuro-HIV; neurocognitive impairment; sedative medication.