AD Biomarker Levels Tied to Neuropsychologic Performance in Women With and Without HIV

Among women living with and without HIV, increases in certain plasma biomarkers may be associated with worse neuropsychologic performance and onset of Alzheimer disease (AD), according to study findings published in JAMA Network Open. 

Researchers of a longitudinal prospective cohort study aimed to assess whether changes in AD biomarker levels had an effect on neuropsychologic performance in women living with and without HIV.

Eligible participants were women aged 40 and older who were enrolled in the Women’s Interagency HIV Study (WIHS) between April and December 2022. Sociodemographic data, clinical (such as body weight and height) and neurologic measures (such as memory loss and confusion), and history of health conditions were recorded. In women living with HIV, laboratory-confirmed HIV status and viral load were also noted.

Primary outcomes were neuropsychologic performance scores, which were assessed based on attention; executive function; processing speed; memory; learning; verbal fluency; and fine motor skills.

A total of 307 women (209 living with HIV and 98 without HIV; 96% aged 50 and older; 53% Black) were included in the analysis.

The researchers found that women living with HIV vs without HIV had worse learning (47.8 vs 51.4), memory (48.3 vs 52.4), verbal fluency (48.3 vs 50.7), and global (49.2 vs 51.1) T-scores.

Median plasma levels of AD biomarkers amyloid-β40 (Aβ40), glial fibrillary acidic protein (GFAP), and neurofilament (NFL) were higher at baseline among women living with HIV vs without HIV.

Among women living with HIV, higher baseline biomarker t-tau levels were associated with a better learning performance (β, 1.15; 95% CI, 0.11-2.18; P = .03), while among women living without HIV, a higher Aβ42 to Aβ40 ratio was associated with better attention (β, 137.04; 95% CI, 0.78-273.29; P = .049).

Adjusting for HIV status, increases in Aβ40, Aβ42, p-tau₂₃₁, and NFL levelsresulted in worse motor performance among all women. Increases in Aβ40 and in Aβ42 were associated with worse learning. In addition, greater NFL levels were associated with worse processing speed and verbal performance.

Stratifying by HIV status, women living with HIV with increases in Aβ40 had worse learning, memory, and global neuropsychologic performance, and greater t-tau levels led to worse executive function. However, decreases in NFL levels were associated with worse processing speed in this population.

In women living without HIV, increases in Aβ40 and Aβ42, and NFL levels were associated with worse memory and motor performances, respectively.

Limitations of the analysis were the lack of specificity of the biomarkers and the lack of generalizability as the study’s population was primarily Black women living in urban areas with a good level of education.

“[M]easuring these biomarkers could be a pivotal advancement in monitoring aging brain health and development of AD among women with and without HIV,” the researchers concluded.

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the authors’ disclosures.