Cognitive burden of common non-antiretroviral medications in HIV-infected women

Leah H. Rubin, Kendra K. Radtke, Seenae Eum, Bani Tamraz, Krithika N. Kumanan, Gayle Springer, Pauline M. Maki, Kathryn Anastos, Daniel Merenstein, Roksana Karim, Kathleen M. Weber, Deborah Gustafson, Ruth M. Greenblatt, Jeffrey R. Bishop

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Objective: The aging HIV population has increased comorbidity burden and consequently non-antiretroviral medication utilization. Many non-antiretroviral medications have known neurocognitive-adverse effects ("NC-AE medications"). We assessed the cognitive effects of NC-AE medications in HIV+ and HIV-women. Methods: One thousand five hundred fifty-eight participants (1037 HIV+; mean age 46) from the Women's Interagency HIV Study completed a neuropsychological test battery between 2009 and 2011. The total number of NC-AE medications and subgroups (eg, anticholinergics) were calculated based on self-report. Generalized linear models for non-normal data were used to examine the cognitive burden of medications and factors that exacerbate these effects. Results: HIV+ women reported taking more NC-AE medications vs. HIV-women (P < 0.05). NC-AE medication use altogether was not associated with cognitive performance. However, among NC-AE medication subgroups, anticholinergic-acting medications, but not opioids or anxiolytics/anticonvulsants, were negatively associated with performance. HIV status moderated the association between these NC-AE medication subgroups and performance (P's < 0.05). HIV-serostatus differences (HIV-< HIV+) in global, learning, fluency, and motor function were greatest among women taking >1 anticholinergic medications. HIV-serostatus differences in performance on learning and psychomotor speed were also greatest among women taking 1 or more anxiolytics/anticonvulsants and 1 or more opioids, respectively. Conclusions: HIV+ women have increased cognitive vulnerabilities to anticholinergic, anxiolytic/anticonvulsant, and opioid medications. Potential synergy between these medications and HIV may explain some HIV-related cognitive impairments. It may be important clinically to consider these specific types of medications as a contributor to impaired cognitive performance in HIV+ women and assess the cost/benefit of treatment dosage for underlying conditions.

Original languageEnglish (US)
Pages (from-to)83-91
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number1
StatePublished - Sep 1 2018


  • HIV
  • anticholinergic
  • cognition
  • women

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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