The number of people with HIV (PWH) experiencing age-associated comorbidities including those treated with medications and cognitive impairment is increasing. We examined associations between polypharmacy and cognition in older women with HIV (WWH) given their vulnerability to this comorbidity. Cross-sectional analysis capitalizing on Women's Interagency HIV Study data collected between 2014 and 2017. WWH meeting the following criteria were analyzed: age ≥50 years; availability of self-reported non-antiretroviral therapy (ART) medications data; and neuropsychological data. The number of non-ART medications used regularly in the prior 6 months was summed. Polypharmacy was categorized as none/low (0–4), moderate (5–9), or severe (≥10). Multivariable linear regression analyses examined polypharmacy-cognition (T-score) associations in the total sample and among virally suppressed (VS; < 20 copies/mL)-WWH after covariate adjustment for enrollment site, income, depressive symptoms, substance use (smoking, heavy alcohol, marijuana, crack, cocaine, and/or heroin), the Veterans Aging Cohort Study index (indicators of HIV disease and organ system function, hepatitis C virus serostatus), ART use, nadir CD4 count, and specific ART drugs (efavirenz, integrase inhibitors). We included 637 women (median age = 55 years; 72% Black). Ninety-four percent reported ART use in the past 6 months and 75% had HIV RNA <20 copies/mL. Comorbidity prevalence was high (61% hypertension; 26% diabetes). Moderate and severe polypharmacy in WWH were 34% and 24%. In WWH, severe polypharmacy was associated with poorer executive function (p = .007) and processing speed (p = .01). The same pattern of findings remained among VS-WWH. Moderate polypharmacy was not associated with cognition. Moderate and severe polypharmacy were common and associated with poorer executive function and processing speed in WWH. Severe polypharmacy may be a major contributor to the persistence of domain-specific cognitive complications in older WWH above and beyond the conditions that these medications are used to treat.

中文翻译：

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感染艾滋病毒的老年女性的多重用药程度和认知功能

患有与年龄相关的合并症（包括接受药物治疗和认知障碍的患者）的艾滋病毒感染者 (PWH) 人数正在增加。鉴于老年女性艾滋病毒 (WWH) 易患这种合并症，我们研究了她们的多重用药与认知之间的关联。利用 2014 年至 2017 年期间收集的妇女机构间艾滋病毒研究数据进行横断面分析。对符合以下标准的 WWH 进行了分析：年龄≥50 岁；自我报告的非抗逆转录病毒治疗（ART）药物数据的可用性；和神经心理学数据。对过去 6 个月内定期使用的非 ART 药物的数量进行了总结。多重用药被分类为无/低度（0-4）、中度（5-9）或重度（≥10）。在对入组地点、收入、抑郁症状、物质使用（吸烟、重度酒精、大麻、强效快克、可卡因和/或海洛因）、退伍军人衰老队列研究指数（HIV 疾病和器官系统功能指标、丙型肝炎病毒血清状态）、ART 使用、最低 CD4 计数和特定 ART 药物（依非韦伦） ，整合酶抑制剂）。我们纳入了 637 名女性（中位年龄 = 55 岁；72% 是黑人）。94% 的人报告在过去 6 个月内使用过 ART，75% 的 HIV RNA <20 拷贝/mL。合并症患病率很高（61% 为高血压；26% 为糖尿病）。WWH 中度和重度多重用药比例分别为 34% 和 24%。在世界卫生大会上，p  = .007) 和处理速度 ( p  = .01)。VS-WWH 中也存在同样的调查结果。中度多重用药与认知无关。在 WWH 中，中度和重度的多重用药很常见，并且与较差的执行功能和处理速度相关。严重的多重用药可能是导致老年 WWH 中特定领域认知并发症持续存在的一个主要原因，这些并发症超出了这些药物用于治疗的病症。