Benzodiazepine Use Is Associated With an Increased Risk of Neurocognitive Impairment in People Living With HIV.

TitleBenzodiazepine Use Is Associated With an Increased Risk of Neurocognitive Impairment in People Living With HIV.
Publication TypeJournal Article
Year of Publication2019
AuthorsSaloner, R, Grelotti, DJ, Tyree, G, Sundermann, EE, Ma, Q, Letendre, S, Heaton, RK, Cherner, M
JournalJ Acquir Immune Defic Syndr
Volume82
Issue5
Pagination475-482
Date Published2019 12 15
ISSN1944-7884
KeywordsAdult, Aged, Alprazolam, Benzodiazepines, Cross-Sectional Studies, Diazepam, Executive function, Female, HIV Infections, Humans, Lorazepam, Male, Memory, Short-Term, Mental Recall, Mental Status and Dementia Tests, Middle Aged, Motor Skills, neurocognitive disorders, Propensity Score, Retrospective Studies, Self Report, Young Adult
Abstract

OBJECTIVE: Despite potential for dependence and adverse neurological effects, long-term benzodiazepine (BZD) use is common among people living with HIV (PLWH). As PLWH are at risk for central nervous system dysfunction, we retrospectively examined the association between BZD use and HIV-associated neurocognitive impairment (NCI).METHODS: Three hundred six PLWH underwent comprehensive neurobehavioral evaluations. Current BZD use (BZD+) was determined through self-report. Using propensity scores, 153 BZD- individuals were matched to 153 BZD+ participants on demographics and medical comorbidities. Multiple regression models examined NCI and demographically adjusted neurocognitive T-scores as a function of BZD status, adjusting for estimated premorbid ability, current affective symptoms, and nadir CD4 count. Secondary analyses explored neurocognitive correlates of positive BZD urine toxicology screens (TOX+) and specific BZD agents.RESULTS: Median duration of BZD use was 24 months. Current BZD use related to higher likelihood of NCI (odds ratio = 2.13, P = 0.003) and poorer global (d = -0.28, P = 0.020), processing speed (d = -0.23, P = 0.047), and motor T-scores (d = -0.32, P = 0.008). Compared with BZD-/TOX-, BZD+/TOX+ exhibited additional decrements in executive function (d = -0.48, P = 0.013), working memory (d = -0.49, P = 0.011), and delayed recall (d = -0.41, P = 0.032). For individual agents, diazepam, lorazepam, and alprazolam were most strongly associated with NCI (odds ratios >2.31).DISCUSSION: BZD use may elevate risk for NCI in PLWH, potentially through diffuse neurocognitive slowing and acute compromise of recall and higher-order capacities. These effects are robust to psychosocial and HIV-specific factors and occur in comparison with a tightly matched BZD- group. Prospective and interventional studies should evaluate causal associations between NCI and BZD use and explore treatment alternatives to BZDs in PLWH.

DOI10.1097/QAI.0000000000002183
Alternate JournalJ Acquir Immune Defic Syndr
PubMed ID31714426
PubMed Central IDPMC6857713
Grant ListP50 DA026306 / DA / NIDA NIH HHS / United States
HHSN271201000030C / MH / NIMH NIH HHS / United States
U24 MH100928 / MH / NIMH NIH HHS / United States
HHSN271201000036C / MH / NIMH NIH HHS / United States
R24 MH059745 / MH / NIMH NIH HHS / United States
T32 AA013525 / AA / NIAAA NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
N01 MH022005 / MH / NIMH NIH HHS / United States
U01 MH083506 / MH / NIMH NIH HHS / United States
F31 AG064989 / AG / NIA NIH HHS / United States