No Association Between Human Immunodeficiency Virus Infections And Dementia: A Nationwide Cohort Study In Taiwan

Figures & data

Table 1 Characteristics Of Study At The Baseline

HIV Infections	Total		With		Without		P
	Variables	n	%	n	%	n	%
	5,044		1,261	25.00	3,783	75.00
Gender							0.999
Male	4,352	86.28	1,088	86.28	3,264	86.28
Female	692	13.72	173	13.72	519	13.72
Age (years)	56.68±8.06		59.37±8.33		59.78±7.97		0.118
Age group (years)							0.999
50–64	3,852	76.37	963	76.37	2,889	76.37
≥65	1,192	23.63	298	23.63	894	23.63
Education (years)							0.519
<12	2,979	59.06	735	58.29	2,244	59.32
≥12	2,065	40.94	526	41.71	1,539	40.68
Insured premium (NT$)							0.447
<18,000	4,579	90.78	1,140	90.40	3,439	90.91
18,000–34,999	319	6.32	88	6.98	231	6.11
≥35,000	146	2.89	33	2.62	113	2.99
DM							<0.001
Without	4,345	86.14	1,124	89.14	3,221	85.14
With	699	13.86	137	10.86	562	14.86
HTN							<0.001
Without	4,318	85.61	1,117	88.58	3,201	84.62
With	726	14.39	144	11.42	582	15.38
Hyperlipidemia							0.002
Without	4,879	96.73	1,236	98.02	3,643	96.30
With	165	3.27	25	1.98	140	3.70
CAD							<0.001
Without	4,580	90.80	1,198	95.00	3,382	89.40
With	464	9.20	63	5.00	401	10.60
Obesity							0.414
Without	5,042	99.96	1,261	100.00	3,781	99.95
With	2	0.04	0	0.00	2	0.05
All cancers							0.193
Without	4,587	90.94	1,135	90.01	3,452	91.25
With	457	9.06	126	9.99	331	8.75
Depression							<0.001
Without	5,013	99.39	1,237	98.10	3,776	99.81
With	31	0.61	24	1.90	7	0.19
Bipolar disorder							0.414
Without	5,042	99.96	1,261	100.00	3,781	99.95
With	2	0.04	0	0.00	2	0.05
Anxiety							0.192
Without	5,016	99.44	1,251	99.21	3,765	99.52
With	28	0.56	10	0.79	18	0.48
Alcohol use disorders							0.228
Without	5,029	99.70	1,255	99.52	3,774	99.76
With	15	0.30	6	0.48	9	0.24
Substance use disorders							<0.001
Without	5,009	99.31	1,229	97.46	3,780	99.92
With	35	0.69	32	2.54	3	0.08
Insomnia							0.595
Without	5,025	99.62	1,255	99.52	3,770	99.66
With	19	0.38	6	0.48	13	0.34
CCI_R	0.42±0.74		0.23±0.54		0.49±0.79		<0.001
Location							<0.001
Northern Taiwan	2,057	40.78	614	48.69	1,443	38.14
Middle Taiwan	1,360	26.96	303	24.03	1,057	27.94
Southern Taiwan	1,341	26.59	322	25.54	1,019	26.94
Eastern Taiwan	266	5.27	20	1.59	246	6.50
Outlets islands	20	0.40	2	0.16	18	0.48
Urbanization level							<0.001
1 (The highest)	1,837	36.42	574	45.52	1,263	33.39
2	2,103	41.69	544	43.14	1,559	41.21
3	323	6.40	46	3.65	277	7.32
4 (The lowest)	781	15.48	97	7.69	684	18.08
Level of care							<0.001
Medical center	1,995	39.55	789	62.57	1,206	31.88
Regional hospital	1,504	29.82	394	31.25	1,110	29.34
Local hospital	1,545	30.63	78	6.19	1,467	38.78

Abbreviations: HIV, human immunodeficiency virus; NT$, New Taiwan Dollars; DM, diabetes mellitus; HTN, hypertension; CAD, coronary artery disease, CCI-R, Charlson Comorbidity Index, dementia removed; P, Chi-square/Fisher exact test on category variables and independent-samples Student’s t-test on continue variables.

Figure 1 The flowchart of study sample selection from National Health Insurance Research Database in Taiwan.

Table 2 Factors Of Dementia By Using Cox Regression And Fine & Gray’s Competing Risk Model

	Competing Risk In The Model
Variables	Crude HR	95% CI	95% CI	P	Adjusted HR	95% CI	95% CI	P
HIV
With	0.682	0.109	2.576	0.572	0.852	0.189	2.886	0.415
Gender
Male	1.443	0.968	2.151	0.072	1.483	0.993	2.214	0.054
Age group (years)
≥65	0.903	0.678	1.202	0.484	0.943	0.704	1.264	0.696
Education (years)
≥12	0.997	0.588	1.596	0.703	1.012	0.699	2.045	0.752
Insured premium (NT$)
<18,000	Reference				Reference
18,000–34,999	0.000	–	–	0.941	0.000	–	–	0.931
≥35,000	0.000	–	–	0.983	0.000	–	–	0.980
DM
With	1.094	0.818	1.483	0.543	1.028	0.764	1.382	0.856
HTN
With	0.839	0.635	1.110	0.219	0.813	0.609	1.086	0.161
Hyperlipidemia
With	0.650	0.289	1.462	0.297	0.756	0.331	1.726	0.506
CAD
With	0.725	0.488	1.123	0.150	0.736	0.470	1.154	0.162
Obesity
With	–	–	–	–	–	–	–	–
All cancers
With	0.288	0.161	0.514	<0.001	0.312	0.173	0.561	<0.001
Depression
With	3.240	1.868	6.262	<0.001	2.975	1.538	5.753	0.001
Bipolar disorder
With	0.000	–	–	0.946	0.000	–	–	0.981
Anxiety
With	2.585	0.828	8.073	0.102	1.278	0.357	4.571	0.706
Alcohol use disorders
With	6.622	1.645	26.657	0.008	7.243	1.752	29.948	0.006
Substance use disorders
With	3.928	0.551	28.034	0.172	2.521	0.316	20.086	0.383
Insomnia
With	2.298	1.022	5.167	0.044	1.846	0.799	4.264	0.151
CCI_R	1.368	1.208	1.549	<0.001	1.353	1.202	1.545	<0.001
Location
Northern Taiwan	Reference				Multicollinearity with urbanization level
Middle Taiwan	1.120	0.826	1.517	0.466	Multicollinearity with urbanization level
Southern Taiwan	0.891	0.839	1.244	0.498	Multicollinearity with urbanization level
Eastern Taiwan	1.695	1.096	2.622	0.018	Multicollinearity with urbanization level
Outlets islands	2.556	0.628	10.383	0.189	Multicollinearity with urbanization level
Urbanization level
1 (The highest)	0.651	0.468	0.907	0.011	0.852	0.582	1.248	0.412
2	0.594	0.434	0.912	0.001	0.736	0.528	1.030	0.074
3	0.566	0.318	1.007	0.053	0.559	0.313	1.000	0.050
4 (The lowest)	Reference				Reference
Level of care
Medical center	0.519	0.376	0.716	<0.001	0.562	0.386	0.818	0.003
Regional hospital	0.642	0.476	0.865	0.004	0.673	0.496	0.914	0.011
Local hospital	Reference				Reference

Abbreviations: HIV, human immunodeficiency virus; NT$, New Taiwan Dollars; DM, diabetes mellitus; HTN, hypertension; CAD, coronary artery disease, CCI-R, Charlson Comorbidity Index, dementia removed; HR, hazard ratio, CI, confidence interval, P, Chi-square/Fisher exact test on category variables and t-test on continue variables; adjusted HR, adjusted variables listed in this table.

Table 3 Factors Of Dementia Subgroup By Using Cox Regression And Fine & Gray’s Competing Risk Model

	HIV			Non-UIV			Competing Risk In The Model
Dementia Subgroups	Event	PYs	Rate (Per 10^5 PYs)	Event	PYs	Rate(Per 10^5 PYs)	Adjusted HR	95% CI	95% CI	P
Total	25	3,809.55	656.25	227	24,859.12	913.15	0.852	0.189	2.886	0.415
AD	1	3,809.55	26.25	9	24,859.12	36.20	0.860	0.191	2.921	0.365
VaD	0	3,809.55	0.00	20	24,859.12	80.45	0.000	–	–	0.964
Other dementia	24	3,809.55	630.00	198	24,859.12	796.49	0.938	0.208	3.785	0.409

Abbreviations: HIV, human immunodeficiency virus; AD, Alzheimer's dementia; VaD, vascular dementia; PYs, person-years; adjusted HR, adjusted hazard ratio: adjusted for the variables listed in Table 1; CI, confidence interval.

Figure 2 Kaplan–Meier for cumulative incidence of dementia aged 50 and over stratified by HIV with log rank test.

Figure 3 Kaplan–Meier for cumulative incidence of dementia aged 50 and over stratified by HAART users and non-users with log rank test.

Table 4 Factors Of Dementia Subgroup Among HIV Cohort By Using Cox Regression And Fine & Gray’s Competing Risk Model

HAART	With		Without		Competing Risk In The Model
Dementia subgroups	Event	Rate (Per 10^5 PYs)	Event	Rate (Per 10^5 PYs)	Adjusted HR	95% CI	95% CI	P
Overall	1	42.62	24	1,640.15	0.030	0.001	168.45	0.885
AD	0	0.00	1	68.34	0.000	–	–	–
VaD	0	0.00	0	0.00	–	–	–	–
Other dementia	1	42.62	23	1,571.81	0.035	0.007	233.12	0.872

Abbreviations: PYs, person-years; HARRT, highly active antiretroviral therapy; adjusted HR, adjusted hazard ratio: adjusted for the variables listed in Table 1; CI, confidence interval.