Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort study
Bibliographic record
Abstract
Introduction: Dementia is a progressive and debilitating disease, and people living with HIV (PLWH) often develop dementia much earlier than those not living with HIV. We estimated the incidence and prevalence of dementia and identified its key risk factors in a cohort of PLWH in British Columbia, Canada. Methods: This retrospective cohort study used data from the Seek and Treat for Optimal Prevention of HIV/AIDS study. Eligible individuals were diagnosed with HIV, ≥40 years of age, naïve to antiretroviral therapy (ART), had no dementia at the index date and were followed for ≥1 year during 2002-2016. Our main outcome was incident dementia. We examined the effect of sociodemographic and clinical covariates on the incidence of dementia using a cause-specific hazard (CSH) model, with all-cause mortality as a competing risk event. Results: (adjusted CSH (aCSH) 8.61, 95% CI: 4.75 to 15.60), uncontrolled viremia (aCSH 1.95, 95% CI: 1.20 to 3.17), 10-year increase in age (aCSH 2.41, 95% CI: 1.89 to 3.07), schizophrenia (aCSH 2.85, 95% CI: 1.69 to 4.80), traumatic brain injury (aCSH 2.43, 95% CI: 1.59 to 3.71), delirium (aCSH 2.27, 95% CI: 1.45 to 3.55), substance use disorder (SUD) (aCSH 1.94, 95% CI: 1.18 to 3.21) and mood/anxiety disorders (aCSH 1.80, 95% CI: 1.13 to 2.86) were associated with an increased hazard for dementia. Initiating ART in 2005-2010 (versus<2000) produced an aCSH of 0.51 (95% CI: 0.30 to 0.89). Conclusions: We demonstrated the negative role of immunosuppression and inflammation on the incidence of dementia among PLWH. Our study also calls for the enhanced integration of care services provided for HIV, mental health, SUD and other risk-inducing comorbidities as a means of lowering the risk of dementia within this population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".