Identifying intervention opportunities in the continuum of cognitive impairment among persons aging with HIV

The National Institute of Mental Health awarded The Johns Hopkins University $149,190 on August 2, 2026, under the Mental Health Research Grants program (CFDA 93.242) to identify intervention opportunities in the continuum of cognitive impairment among persons aging with HIV.

The research will estimate the proportion of cognitive impairment cases among people with HIV potentially attributable to psychosocial and behavioral risk factors, prioritizing those interventions that could prevent the greatest number of cases. The project will also determine whether cognitive impairment increases the risk of losing sustained viral suppression, enabling mitigation of this adverse outcome. The work leverages longitudinal cognitive screening data from the Multicenter AIDS Cohort Study and the Johns Hopkins HIV Clinical Cohort to estimate population attributable fractions for incident cognitive impairment using methods accounting for time-varying risk factors, censoring, and competing risks.

Performance occurs in Baltimore, Maryland, with a period of performance from August 2, 2026, through February 1, 2027. This is a project grant, a nonrenewable award supporting a single research project for a specified period.

Abstract

Specific aims: this proposal aims to identify opportunities to improve the prevention and mitigation of risks associated with cognitive impairment among people aging with HIV. Aim 1 will estimate the proportion of cognitive impairment cases potentially attributable to psychosocial and behavioral risk factors to prioritize those, which if intervened upon, could hypothetically result in the greatest prevention of cognitive impairment. Aim 2 will determine whether cognitive impairment increases the risk of losing one's durable (sustained) viral suppression so we may mitigate this adverse outcome. Significance: as people with HIV (PWH) live longer due to treatment advances, they face a growing burden of age-related conditions, including cognitive impairment. PWH experience higher rates of cognitive impairment than people without HIV despite widespread viral suppression, which implicates non-HIV-related factors in their cognitive risk. Focusing on psychosocial and behavioral risk factors, which are prevalent in PWH and causally linked to cognitive impairment, can help to prioritize fruitful prevention strategies. In addition, cognitive impairment may threaten the durability of viral suppression, which could hinder cognitive maintenance and prevention of HIV transmission. Considering these issues in tandem can inform preparations for the long-term healthcare needs of people aging with HIV. Approach: these aims will leverage the multicenter aids cohort study (macs) (aim 1), which includes 10 years of longitudinal cognitive screening data, and the johns hopkins HIV clinical cohort (jhhcc) (aim 2), an urban cohort of PWH with rich clinical data. In aim 1, we will estimate population attributable fractions for incident cognitive impairment, using longitudinal data and methods to account for time-varying risk factors, censoring, and competing risks. In aim 2, we will employ a longitudinal closed cohort design to estimate the risk ratio for loss of durable viral suppression in PWH by cognitive impairment status. Training information: the proposed research encompasses the dissertation of madeline brooks, a PHD student in the department of epidemiology at the johns hopkins bloomberg school of public health. The training plan consists of coursework, mentorship, and professional development to support the successful completion of these aims and prepare MS. Brooks to become an independent research epidemiologist. These aims address priorities of the NIH office of aids research to address the role of non-infectious comorbidities in central nervous system complications and subsequent implications for HIV transmission.