NYMC Faculty Publications

Degree of Polypharmacy and Cognitive Function in Older Women With HIV


Leah H. Rubin, Department of Neurology and Baltimore, Maryland, USA.
Ava G. Neijna, Department of Neurology and Baltimore, Maryland, USA.
Qiuhu Shi, New York Medical College, Valhalla, New York, USA.
Donald R. Hoover, Rutgers University, Piscataway, New Jersey, USA.
Bani Tamraz, Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA.
Kathryn Anastos, Albert Einstein College of Medicine, Bronx, New York, USA.
Andrew Edmonds, Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Margaret A. Fischl, University of Miami Health System, Miami, Florida, USA.
Deborah Gustafson, Department of Neurology, SUNY-Downstate Medical Center, Brooklyn, New York, USA.
Pauline M. Maki, Department of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.
Daniel Merenstein, Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA.
Anandi N. Sheth, Emory School of Medicine, Atlanta, Georgia, USA.
Gayle Springer, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
David Vance, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA.
Kathleen M. Weber, Cook County Health & Hospital System/Hektoen Institute of Medicine, Chicago, Illinois, USA.
Anjali Sharma, Albert Einstein College of Medicine, Bronx, New York, USA.

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AIDS Research and Human Retroviruses

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Public Health


The number of people with HIV (PWH) experiencing age-associated comorbidities including those treated with medications and cognitive impairment is increasing. We examined associations between polypharmacy and cognition in older women with HIV (WWH) given their vulnerability to this comorbidity. Cross-sectional analysis capitalizing on Women's Interagency HIV Study data collected between 2014 and 2017. WWH meeting the following criteria were analyzed: age ≥50 years; availability of self-reported non-antiretroviral therapy (ART) medications data; and neuropsychological data. The number of non-ART medications used regularly in the prior 6 months was summed. Polypharmacy was categorized as none/low (0-4), moderate (5-9), or severe (≥10). Multivariable linear regression analyses examined polypharmacy-cognition (T-score) associations in the total sample and among virally suppressed (VS; < 20 copies/mL)-WWH after covariate adjustment for enrollment site, income, depressive symptoms, substance use (smoking, heavy alcohol, marijuana, crack, cocaine, and/or heroin), the Veterans Aging Cohort Study index (indicators of HIV disease and organ system function, hepatitis C virus serostatus), ART use, nadir CD4 count, and specific ART drugs (efavirenz, integrase inhibitors). We included 637 women (median age = 55 years; 72% Black). Ninety-four percent reported ART use in the past 6 months and 75% had HIV RNA <20 copies/mL. Comorbidity prevalence was high (61% hypertension; 26% diabetes). Moderate and severe polypharmacy in WWH were 34% and 24%. In WWH, severe polypharmacy was associated with poorer executive function ( = .007) and processing speed ( = .01). The same pattern of findings remained among VS-WWH. Moderate polypharmacy was not associated with cognition. Moderate and severe polypharmacy were common and associated with poorer executive function and processing speed in WWH. Severe polypharmacy may be a major contributor to the persistence of domain-specific cognitive complications in older WWH above and beyond the conditions that these medications are used to treat.