Cognitive Burden of Common Non-antiretroviral Medications in HIV-Infected Women

J Acquir Immune Defic Syndr. 2018 Sep 1;79(1):83-91. doi: 10.1097/QAI.0000000000001755.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Analgesics, Opioid / adverse effects
  • Anti-Anxiety Agents / adverse effects
  • Anti-HIV Agents / therapeutic use
  • Antidepressive Agents / adverse effects
  • Antihypertensive Agents / adverse effects
  • Cognitive Dysfunction / chemically induced*
  • Comorbidity
  • Cross-Sectional Studies
  • Drug-Related Side Effects and Adverse Reactions
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Histamine Antagonists / adverse effects
  • Humans
  • Medication Adherence
  • Middle Aged
  • Neuropsychological Tests


  • Analgesics, Opioid
  • Anti-Anxiety Agents
  • Anti-HIV Agents
  • Antidepressive Agents
  • Antihypertensive Agents
  • Histamine Antagonists