(SLA-161) Prevalence and Mortality of HIV-Associated Neurocognitive Disorder (HAND) in Older Medicare Beneficiaries

Background: HIV-associated neurocognitive disorder (HAND) remains a prevalent but understudied complication among adults with HIV, potentially leading to worsened health outcomes and increased healthcare burdens. Understanding the prevalence and mortality impact of HAND in the Medicare population is crucial for guiding targeted interventions, optimizing healthcare resource allocation, and improving health outcomes for older adults with HIV.

Objectives: This study aims to assess the prevalence of HAND among older adults with HIV and investigate the association between HAND and mortality.

Methods: A retrospective cohort study was conducted using the 5% national sample of Medicare administrative claims data from 2012 to 2020. Of Medicare beneficiaries aged 65 and older with HIV, those with a HAND diagnosis were identified using the diagnosis codes. For the HAND-exposed group, the date of the first claim of HAND was set as the index date, and a random index date was assigned to the HAND-unexposed group based on the distribution of the HAND-exposed group. Beneficiaries were required to be continuously enrolled in Medicare Parts A, B, and D, but not Part C for at least 6 months before the index date. Mortality was identified by using the date of death information from the Medicare master beneficiary summary file and censoring occurred at disenrollment, hospice use, or study end date. The association between HAND and mortality was assessed using Cox proportional hazards models, adjusting for sociodemographic, and clinical characteristics.

Results: Among 4,070 Medicare beneficiaries aged 65 years and older diagnosed with HIV between 2012 and 2019, 765 had HIV-Associated Neurocognitive Disorder (HAND), yielding a period prevalence of 18.8%. After applying inclusion and exclusion criteria, 1,274 HIV patients were included in the survival analysis. The cohort had a mean age of 70.31 years (SD = 6.38), with HAND patients being older (73.31 vs. 68.85 years). In this predominantly White (52.2%) and male (69.3%) cohort, females were more prevalent in the HAND group compared to non-HAND patients (39.9% vs. 27.4%). Patients with HAND exhibited significantly lower survival probabilities compared to those without HAND (Log-rank p< 0.001), with survival rates declining to 45% versus over 70%, respectively, by the end of the follow-up period. After adjusting for covariates in the Cox regression model, HAND diagnosis was found to be associated with a two-fold increase in the hazard of mortality (aHR = 2.121, 95% CI: 1.533-2.937, p< 0.001).

Conclusions: Our findings highlight the significant prevalence and mortality burden of HAND among older adults with HIV. Given the increased mortality associated with HAND, routine neurocognitive screening in older adults with HIV is essential.