Is there a relationship between the route of HIV transmission and cognitive performance in older individuals living with HIV?

Background: - HIV-related neurocognitive disorders are a growing public health issue, especially in older people living with HIV/AIDS (PLWHA). The aim of this study is to evaluate the relationship between cognitive performance and route of HIV transmission in an older group of PLWHA. Methods: - In this cross-sectional study, conducted between November 2022 and July 2023, we enrolled PLWHA aged 50 years or older, treated with highly active anti-retroviral therapy, and with a low/undetectable viral load. Cognitive assessment was performed with HIV Dementia Scale. Results: In total, 268 subjects were enrolled. Cognitive impairment was present in 20.9% of the participants. According to a logistic model, people who contracted HIV through sexual transmission had 74% lower odds of cognitive impairment compared to those who contracted HIV through intravenous substance use (OR: 0.26, 95%CI 0.12–0.56). The adjustment for confounders confirmed lower odds for sexual transmission (OR: 0.27, 95%CI 0.12–0.60). Conclusions: The route of HIV transmission is potentially associated with cognitive impairment in PLWHA, with patients infected via intravenous substance use being at higher risk.