Background Alterations in brain function and structure, such as depression and neurocognitive impairment, continue to occur in people with human immunodeficiency virus (HIV, PWH) taking suppressive antiretroviral therapy (ART). The lifespan of PWH has improved but the healthspan remains worse than people without HIV, in part because of aging-related diseases. As a result, polypharmacy is common and increases the risk of drug-drug interactions and adverse reactions. Methods This cross-sectional project investigated the relationship between 7 medication-related metrics (including anticholinergic burden), depressive symptoms, and neurocognitive performance in 491 PWH at a single center in the United States. All participants were taking ART and had plasma HIV RNA ≤ 200 copies/mL. Results Participants had taken ART for a mean of 6.5 years, and most (57.6%) had CD4+ T-cells >500/µL. All 7 medication-related metrics were associated with worse global neurocognitive performance (P value <.0001 to .0087). Multivariable models confirmed that higher anticholinergic burden (P = .040) and use of benzodiazepines (P = .033), antidepressants (P = .0011), and more total medications (P = .059) were associated with more depressive symptoms (model P < .0001). Use of benzodiazepines (P = .0024) and opiates (P = .043) along with higher anticholinergic burden (P = .066) were also associated with worse neurocognitive performance. Benzodiazepine use was associated with worse performance in all domains and opiate use was associated with worse performance in processing speed, motor function, executive function, and working memory. Conclusions Use of benzodiazepines, opiates, and anticholinergic drugs contribute to cognitive and mood disorders in PWH. When possible, modifying or deprescribing medications may be beneficial.

中文翻译：

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处方药对人类免疫缺陷病毒 （HIV） 患者抑郁症状和神经认知能力的影响


背景 接受抑制性抗逆转录病毒治疗 （ART） 的人类免疫缺陷病毒 （HIV， PWH） 患者继续发生大脑功能和结构的改变，例如抑郁和神经认知障碍。PWH 的寿命有所延长，但健康寿命仍然比没有 HIV 的人差，部分原因是与衰老相关的疾病。因此，多药治疗很常见，并增加了药物相互作用和不良反应的风险。方法 该横断面项目调查了美国单个中心 491 例 PWH 的 7 项药物相关指标（包括抗胆碱能负担）、抑郁症状和神经认知表现之间的关系。所有参与者均接受 ART 治疗，血浆 HIV RNA ≤ 200 拷贝/mL。结果 参与者平均接受 ART 6.5 年，大多数 （57.6%） 有 CD4+ T 细胞 >500/μL。所有 7 个药物相关指标都与较差的整体神经认知能力相关 （P 值 <.0001 至 .0087）。多变量模型证实，较高的抗胆碱能负担 （P = .040） 和苯二氮卓类药物 （P = .033） 的使用、抗抑郁药 （P = .0011） 和更多的总药物 （P = .059） 与更多的抑郁症状相关 （模型 P < .0001）。使用苯二氮卓类药物 （P = .0024） 和阿片类药物 （P = .043） 以及较高的抗胆碱能负担 （P = .066） 也与较差的神经认知能力有关。苯二氮卓类药物的使用与所有领域的较差表现相关，而阿片类药物的使用与处理速度、运动功能、执行功能和工作记忆方面的较差表现有关。结论 苯二氮卓类药物、阿片类药物和抗胆碱能药物的使用会导致 PWH 的认知和情绪障碍。 在可能的情况下，修改或取消处方药物可能是有益的。