We evaluated the trajectory of cognitive parameters 1 year pre- and post-COVID-19 in people with HIV (PWH) on stable antiretroviral therapy (ART) initiated during acute HIV infection (AHI).

RV254 participants are enrolled during AHI, initiated ART within days and longitudinally followed with a 4-test cognitive battery that evaluated executive function (Color Trails 1&2, CT1&CT2), processing speed (Trail Making A, TMA), and fine motor speed (Grooved Pegboard, GPB). Raw scores were standardized and averaged to determine an overall (NPZ-4) score. In participants on ≥ 48 weeks of stable ART who had COVID-19, cognitive test z-scores 1 year pre- and post-COVID-19 were regressed on time using linear mixed models. Time in years since COVID-19 diagnosis was entered as a linear spline with knots at the time of COVID-19 diagnosis and 0.25-year intervals thereafter; each timepoint after diagnosis was compared with the value at diagnosis.

Between April 2021 and September 2022, 269 participants on ≥48 weeks of stable ART (97% males, median age 32 years) were diagnosed with COVID-19. Compared with values at the time of COVID-19 diagnosis, there were significant declines in the TMA z-score at 3 months (0.90 vs 0.55, p=0.02) and the NPZ-4 score at 6 months (1.02 vs. 0.89, p=0.03) after diagnosis. CT1, CT2, and GPB z-scores remained stable over this period. 

In this cohort of early-treated and virologically suppressed PWH, we observed modest but significant changes in processing speed and overall neurocognitive performance up to 6 months after acute COVID-19. Longitudinal assessments of immune markers in cerebrospinal fluid and brain MRI are ongoing to determine the long-term impact of COVID-19 on neurocognitive outcomes in PWH.