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Poorer cognitive functioning was associated with poor engagement in care among older MSM with HIV who reported chronic pain and substance use.

Poorer cognitive functioning was associated with suboptimal engagement in care in a sample of sexual minority men with HIV aged 50 and older who reported chronic pain and substance use. The findings were published in AIDS Research and Treatment.

Patients with HIV are living longer, with most people with HIV in the United States being aged 50 and older, Conall O’Cleirigh, PhD, and colleagues noted. “However, with longevity come chronic health conditions that adversely impact quality of life, such as HIV-associated and other neurocognitive impairment.”

The study assessed engagement in HIV-related care and functional disability in 63 men who have sex with men living with HIV as well as with chronic pain and recent substance use. The majority identified as White (55%) or Black (42%), with a mean age of 57.2 years.

On the Brief Pain Inventory, in which patients rate pain on a 0 to 10 scale from no pain to the worst pain imaginable, participants’ average pain scores were 5.2, signaling moderate pain levels. Two-thirds met DSM-5 criteria for a substance use disorder.

The mean score on the Montreal Cognitive Assessment (MoCA) was 23.6, indicating mild neurocognitive impairment.

Multidisciplinary Care Indicated in This Patient Population

The researchers found that greater neurocognitive impairment, as measured by the MoCA, was associated with more missed appointments for HIV care in the previous year. Similarly, self-reported cognitive impairment on the Patient Assessment of Own Functioning Inventory was linked with more missed HIV care appointments and greater functional disability. In contrast, poorer semantic fluency was associated with fewer missed appointments for HIV care.

As the first study to investigate relationships between HIV care engagement and neurocognitive impairment in older men who have sex with men, the findings have implications for HIV care, according to Dr. O’Cleirigh and colleagues. Specifically, men experiencing neurocognitive impairment may require targeted intervention to promote attendance at HIV care appointments.

This level of support “may be beyond the scope” of HIV care, the researchers noted, underscoring the importance of linkage to care or healthcare navigation services that are tailored to people aging with HIV.

Additionally, increased brief neuropsychological assessment and referral from primary care may better identify aging patients at risk for suboptimal engagement in HIV care. Addressing comorbid substance use disorder is also critical, Dr. O’Cleirigh and colleagues noted.