# P-236. The Effect of Hospitalization on Neurocognitive Function in People with HIV

## TL;DR

Hospitalization is linked to small but lasting declines in cognitive function among people with HIV, especially those admitted for 3-6 days or for non-surgical reasons.

## Contribution

This study identifies hospitalization as a risk factor for neurocognitive decline in people with HIV, with specific patterns based on admission duration and type.

## Key findings

- Hospitalization was associated with a small but significant decline in neurocognitive scores over time.
- Participants admitted for 3-6 days showed the greatest decline in neurocognitive function.
- Non-surgical hospitalizations were more strongly linked to cognitive decline than surgical ones.

## Abstract

Hospitalization contributes to cognitive decline among older adults without HIV; people with HIV (PWH) may have greater vulnerability for post-hospitalization decline. We aimed to determine the impact of hospitalization on trajectories of neurocognitive function in the long-term observational ACTG HAILO study.Neurocognitive scores (NPZ3 scores) before and after hospitalization

Neurocognitive scores (NPZ3 scores) before and after hospitalization

Demographics and variables at baseline among participants who were hospitalized and had NPZ3 data (N=199)

We included participants who required hospitalization and had neurocognitive assessments before and up to 3 years after hospitalization. Demographics, self-reported information for first hospitalization (baseline) within the prior 6-month period were obtained. Outcomes included an average of 3 normalized z-scores of Trail-Making A and B and Digit symbol (NPZ3), with impairment defined as NPZ3 ≤-2 on 1 normalized z-score or ≤-1 on 2 normalized z-scores and change of 0.5 considered clinically relevant. Potential confounding variables (age, race/ethnicity, education, smoking, BMI, substance use, CD4 and HIV RNA viral load) were included in adjusted models if slope changed by ≥10%.

Of 892 participants, 208 participants had at least 1 hospitalization; 199 had NPZ3 scores before/after hospitalization. The median age was 57 (IQR 51, 62), 38% Black, and 14% Hispanic; median CD4 was 662 cells/mm3 (IQR 450,818), 94% had HIV-1 < 200 copies/ml. 74% were admitted for non-surgical reasons (Table 1). Baseline NPZ3 scores were impaired in 16% admitted for 1-2 days, 14% for 3-6 days and 25% for ≥ 7 days. Adjusting for race/ethnicity, the overall slope of NPZ3 scores before and after hospitalization was -0.103[-0.182, -0.024], p=0.01 (Figure 1), with the greatest change in those admitted for 3-6 days: 0.181[-0.307, -0.054], p= 0.005. Hospitalization for non-surgical reasons was associated with an NPZ3 slope decline of -0.117[-0.212,-0.022], p=0.02 vs surgical reasons -0.071[-0.206, 0.065], p=0.2.

Small but persistent declines in neurocognitive scores were observed following hospitalization, notably in those admitted for 3-6 days and for non-surgical reasons. Monitoring for decline of neurocognitive function post hospitalization could help initiate earlier interventions.

Frank J. Palella, MD, EMD Serono: Honoraria|Gilead Sciences: Honoraria|Merck: Honoraria|ViiV: Honoraria Todd T. Brown, MD, PhD, EMD Serono: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|ViiV: Advisor/Consultant Susan L. Koletar, MD, Gilead Sciences: Co-investigator on several grants; no direct salary support|ViiV Healthcare: Grant/Research Support Kristine M. Erlandson, MD MS, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|ViiV: Advisor/Consultant|ViiV: Travel to meeting