Benzodiazepine Use Is Associated With an Increased Risk of Neurocognitive Impairment in People Living With HIV.
Title | Benzodiazepine Use Is Associated With an Increased Risk of Neurocognitive Impairment in People Living With HIV. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Saloner, R, Grelotti, DJ, Tyree, G, Sundermann, EE, Ma, Q, Letendre, S, Heaton, RK, Cherner, M |
Journal | J Acquir Immune Defic Syndr |
Volume | 82 |
Issue | 5 |
Pagination | 475-482 |
Date Published | 2019 12 15 |
ISSN | 1944-7884 |
Keywords | Adult, 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. |
DOI | 10.1097/QAI.0000000000002183 |
Alternate Journal | J Acquir Immune Defic Syndr |
PubMed ID | 31714426 |
PubMed Central ID | PMC6857713 |
Grant List | HHSN271201000030C / MH / NIMH NIH HHS / United States U24 MH100928 / MH / NIMH NIH HHS / United States R24 MH059745 / MH / NIMH NIH HHS / United States T32 AA013525 / AA / NIAAA NIH HHS / United States N01MH22005 / MH / NIMH NIH HHS / United States P30 MH062512 / MH / NIMH NIH HHS / United States N01 MH022005 / MH / NIMH NIH HHS / United States P50 DA026306 / DA / NIDA NIH HHS / United States K24 DA040550 / DA / NIDA NIH HHS / United States R25 MH081482 / MH / NIMH NIH HHS / United States HHSN271201000036C / MH / NIMH NIH HHS / United States U01 MH083506 / MH / NIMH NIH HHS / United States F31 AG064989 / AG / NIA NIH HHS / United States |