Anticholinergic and sedative medications are associated with neurocognitive performance of well-treated people living with HIV

Abstract Background We previously showed that anticholinergic (ACH) medications contribute to self-reported neurocognitive impairment (NCI) in elderly people living with HIV (PLWH). The current cross-sectional study further evaluated the effect of ACH and sedative drugs on neurocognitive function in PLWH who underwent comprehensive neuropsychological evaluation. Methods A medication review was performed in PLWH enrolled in the prospective Neurocognitive Assessment in Metabolic and Aging Cohort (NAMACO) within the Swiss HIV Cohort Study. Neurocognitive functions were analyzed in 5 domains (motor skills, speed of information, attention/working memory, executive functions and verbal learning memory). The effect of ACH and sedative medications on neurocognitive functioning was evaluated using linear regression models for the continuous (mean z-score) outcome and multivariable logistic regression models for the binary (presence/absence) outcome. Results 963 PLWH (80% male, 92% Caucasian, 96% virologically suppressed, median age 52) were included. 14% of participants were prescribed ≥1 ACH medication and 9% were prescribed ≥1 sedative medication. Overall, 40% of participants had NCI. Sedative medication use was associated with impaired attention/verbal learning and ACH medication use with motor skills deficits both in the continuous (mean z-score difference -0.26 to -0.14, p < 0.001 and p = 0.06) and binary (odds ratio, OR ≥1.67, p < 0.05) models. Their combined use was associated with deficits in overall neurocognitive functions in both models (mean z-score difference -0.12, p = 0.002 and OR 1.54, p = 0.03). These associations were unchanged in a subgroup analysis of participants without depression (n = 824). Conclusion ACH and sedative medications contribute to NCI. Clinicians need to consider these drugs when assessing NCI in PLWH.