Elevated homocysteine levels may moderate and mediate the association between HIV and cognitive impairment among middle-aged and older adults in an underserved population in Baltimore, Maryland

Authors

Hong Lai, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
Glenn Treisman, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
David D. Celentano, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Gary Gerstenblith, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Raul N. Mandler, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
Jag Khalsa, Department of Microbiology, Immunology and Tropical Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Man Charurat, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
Shenghan Lai, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
Godfrey Pearson, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.

Document Type

Journal Article

Publication Date

12-8-2023

Journal

International journal of STD & AIDS

DOI

10.1177/09564624231218762

Keywords

HIV infection; HIV-associated neurocognitive impairment; NIH toolbox cognition battery (NIHTB-CB); causal mediation analysis; cocaine use; elevated homocysteine levels

Abstract

In the antiretroviral therapy (ART) era, HIV-associated neurocognitive disorders (HAND) remain a considerable challenge for people with HIV, yet not all such disorders can be attributed to HIV alone. This study aimed to: (1) identify factors influencing neurocognitive impairment (NCI) utilizing the NIH Toolbox Cognition Battery (NIHTB-CB) as per the revised research criteria for HAND; (2) ascertain the moderating role of high homocysteine levels in the association between NCI and HIV; and (3) assess the mediating effect of elevated homocysteine levels on this association. We analyzed data from 788 adults (≥45 years) participating in a study on HIV-related comorbidities in underserved Baltimore communities, using NIHTB-CB to gauge neurocognitive performance. Special attention was given to results from the Dimensional Change Card Sort (DCCS) test within the executive function domain during causal mediation analysis. Overall, HIV was not associated with NCI presence. However, HIV was associated with NCI among individuals with homocysteine >14 μmol/L. Furthermore, HIV was both directly and indirectly associated with NCI in DCCS test scores. Notably, the mediating role of elevated homocysteine in DCCS scores was only observable among individuals who had never used cocaine or had used it for ≤ 10 years, suggesting that extended cocaine use may have a substantial influence on cognitive performance. The findings from this study suggest elevated homocysteine levels may moderate and mediate the association between HIV and neurocognitive impairment.

APA Citation

Lai, Hong; Treisman, Glenn; Celentano, David D.; Gerstenblith, Gary; Mandler, Raul N.; Khalsa, Jag; Charurat, Man; Lai, Shenghan; and Pearson, Godfrey, "Elevated homocysteine levels may moderate and mediate the association between HIV and cognitive impairment among middle-aged and older adults in an underserved population in Baltimore, Maryland" (2023). GW Authored Works. Paper 3991.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3991

Department

Microbiology, Immunology, and Tropical Medicine