HIV / STI
Prescribing patterns of dementia-specific medication in US persons with HIV and clinically recognized dementia, 2016-2022 Madeline Brooks* Madeline Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks Johns Hopkins Bloomberg School of Public Health
Dementia is a growing concern for aging persons with HIV (PWH). While there is no cure for dementia, drugs to manage symptoms offer modest benefits. Given the history of disparities in HIV treatment prescription among PWH, we characterized dementia-specific medication prescribing patterns in US PWH in the last decade.
Participants included PWH aged ≥50 years with clinically recognized incident dementia between 2016-2022, defined as the first occurrence of an ICD-9/10 diagnosis code or prescription of donepezil, rivastigmine, galantamine, or memantine. Poisson regression with robust variance was used to estimate crude and adjusted prevalence ratios (aPR) and 95% confidence intervals ([,]) for factors associated with receipt of medication, either before receipt of a diagnosis code or at any time over follow-up.
Among 908 PWH with clinically recognized dementia from 2016-2022, most were classified by first dementia diagnosis code (n=730, 80%) and the remaining by first dementia-specific medication (n=178, 20%) (Figure 1). Nearly one-third (n=263, 29%) received a medication during the study period, primarily donepezil. Eighty-five received medication following a diagnosis code (median: 3.4 months, IQR: 5 days, 10.6 months). Those who received a dementia-specific medication (regardless of diagnosis code) were less likely to have low CD4 count (<200 vs. ≥500 cells/µL, aPR=0.46 [0.26, 0.80]), virologic failure (aPR=0.67 [0.49, 0.92]), and cardiovascular disease (aPR=0.71 [0.56, 0.89]) and more likely to be female (aPR=1.36 [1.03, 1.81]) or obese (vs. normal weight, aPR=1.37 [1.06, 1.77]).
PWH who receive dementia-specific medication tend to have better measures of HIV control, which may reflect greater care engagement, medication adherence, or clinical determination that the dementia was unlikely to be HIV-associated, all of which may make medication prescription more appropriate. Sex may also influence the receipt of dementia-specific medications in PWH.
