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Effect of hospitalization on
cognitive and physical function in people with HIV
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Chauhan, Lakshmia; Wu, Kunlingb; Tassiopoulos, Katherineb; Rubin, Leah H.c; Brown, Todd T.d; Abraham, Alisone; Kasirye, Ronnief; Koletar, Susang; Palella, Frank J.h; Erlandson, Kristine M.a
AIDS May 04, 2026.
Discussion
In a large, well-characterized observational cohort, we provide novel data on the impact of hospitalization on abbreviated cognitive battery (primarily psychomotor performance) and physical function among adult PWH (median age 58 years), which is considerably younger than
many other older adult cohorts. We found that intermediate hospitalization duration (3-6 nights) was associated with decrease in NPZ3 scores and grip strength but not gait speed. Not surprisingly, participants who required hospitalization (particularly those with ≥ 7 days hospitalization) also tended to have lower baseline NPZ3, slower gait, and weaker grip compared to those with no hospitalization, suggesting pre-existing vulnerability. Considering that PWH may have a greate burden of cognitive and physical function impairment than populations without HIV, the impact of hospitalization may be particularly relevant to this population and underscores the value ofunderstanding the functional impact of hospitalization on long-term outcomes.
In conclusion, the findings of this study demonstrate modest post-hospitalization declines in cognitive function (mainly psychomotor performance) and physical function in a middle-aged cohort of PWH. Assessment of cognitive and physical function following hospitalization may facilitate timely interventions such as early rehabilitation, exercise programs, and cognitive training to prevent long-term decline.
Background:
Hospitalization contributes to cognitive and physical decline among older adults. We aimed to determine the impact of hospitalization on cognitive and physical function among people with HIV (PWH).
Methods:
Participants who had been hospitalized and had cognitive or physical function assessments were included. Cognitive function (a composite of Z-scores for three cognitive tests; NPZ3), gait speed, and grip strength slope differences before and after hospitalization were adjusted for potential confounding variables.
Results:
Of 892 participants, 208 had ≥1 hospitalization: 198 had NPZ3 scores and 197 had gait/grip measures. The median age was 58 years, 37% were Black, and 14% Hispanic; median CD4 was 656 cells/mm3, 94% had HIV-1 <200 copies/ml. The NPZ-3 slope difference after versus before hospitalization was -0.071 per year (95% CI = -0.167, 0.026), with significant difference among those admitted for 3-6 days (-0.177 [95% CI -0.336, -0.018]) but not <3 or >6 days. The grip strength slope difference was -0.626 kg per year (95% CI -1.749, 0.497), with significant decline among those admitted for 3-6 days (-1.60 kg per year [95% CI -3.04, -1.52], p = 0.03) but not <3 or >6 days. The gait speed increase was significant among those admitted for 3-6 days (0.044 m/s [0.005,0.083], p = 0.03) but not for those with <3 or >6 days.
There was a non-significant decline in gait speed slope difference for participants hospitalized for >7 nights [slope difference =-0.025 m/s, 95%CI = -0.064,0.013, p=0.2] while gait speed slope difference yielded an increase after hospitalization for those with a 3-6 night hospital stay (slope difference = 0.044 m/s, 95% CI= 0.005,0.083 p=0.03; Figure 2; Supplementary Table 3, Supplemental Digital Content, http://links.lww.com/QAD/D865).
Conclusions:
Intermediate duration of hospitalization was associated with modest declines in post-hospitalization cognitive function (predominantly psychomotor performance) and grip strength.
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