LAUSR

OBJECTIVES The number of people with HIV (PWH) experiencing age-associated comorbidities including those treated with medications and cognitive impairment is increasing. We examined associations between polypharmacy and cognition in older women with HIV (WWH) given their vulnerability to this comorbidity. DESIGN Cross-sectional analysis capitalizing on Women's Interagency HIV Study data collected between 2014-2017. METHODS WWH meeting the following criteria were analyzed: age >50 years; availability of self-reported non-ART medications data; and neuropsychological (NP) data. The number of non-ART medications used regularly in the prior 6-months was summed. Polypharmacy was was categorized as none/low (0-4), moderate (5-9), or severe (>10). Multivariable linear regression analyses examined polypharmacy-cognition (T-score) associations in the total sample of WWH and among virally suppressed (VS)-WWH (<20copies/mL) after covariate adjustment for enrollment site, income, depressive symptoms, substance use (smoking, heavy alcohol, marijuana, crack, cocaine, and/or heroin), the Veterans Aging Cohort (VACS) index (indicators of HIV disease and organ system function, hepatitis C virus serostatus), antiretroviral therapy (ART) use, nadir CD4 count, and specific ART drugs (efavirenz, integrase inhibitors). RESULTS We included 637 women (median age=55 years; 72% Black). Ninety-four percent reported ART use in the past 6 months and 75% had HIV RNA <20 copies/ml. Comorbidity prevalence was high (61% hypertension; 26% diabetes). Moderate and severe polypharmacy in WWH were 34% and 24%. In WWH, severe polypharmacy was associated with poorer executive function (P=0.007) and processing speed (P=0.01). The same pattern of findings remained among VS-WWH. Moderate polypharmacy was not associated with cognition. CONCLUSIONS Moderate and severe polypharmacy were common and associated with poorer executive function and processing speed in WWH. Severe polypharmacy may be a major contributor to the persistence of domain-specific cognitive complications in older WWH above and beyond the conditions that these medications are used to treat.