Impact of serologically confirmed SARS-CoV-2 infection on cognitive test performance in a vaccinated HIV+ adult cohort relative to pre-pandemic levels

Objectives: Cognitive abnormalities have been documented following COVID-19 infection. Using pre-pandemic levels of cognitive functioning, we examined the impact of detectable serologic response to COVID-19 infection on cognitive domain performance in a cohort of people with HIV (PWH). We also evaluated the additional impact of potential risk factors for cognitive deficits in the context of SARS-CoV-2 serostatus, including psychiatric variables, number of medical comorbidities, and HIV biomarkers. Methods: 118 ethnically and racially diverse PWH (mean age 63.6; 50% women) completed comprehensive, in-person neuropsychological and medical assessments before the pandemic (March 2018 to March 2020) and at follow-up (August 2020 to June 2024). All but 4 study participants had been vaccinated against SARS-CoV-2 prior to follow-up assessment. 54 participants had anti-SARS-CoV-2 nucleoprotein antibodies. Mixed design repeated-measures ANOVAs were used to compare longitudinal performance among serological groups (anti-N positive, anti-N negative) on global cognitive function and 7 cognitive domains. Subsequently, multivariate regression models were used to examine the role of risk factors on cognitive functioning stratified by SARS-CoV-2 serostatus. Results: Positive anti-N serostatus did not influence cognitive test performance, self-perceived stress and depressive mood when compared to pre-pandemic levels. When stratified by serostatus, only greater number of medical comorbidities predicted worse motor domain functioning in the anti-N negative group. Conclusion: Serological response to COVID-19 infection had no deleterious cognitive or psychological impact relative to pre-pandemic levels. Number of medical comorbidities and HIV biomarkers may play a more central role on cognitive outcomes.