Electronic Health Record-Based Dementia Prediction for HIV Primary Care

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PROJECT SUMMARY Jennifer Lam PhD, MPH is an infectious disease epidemiologist whose research focuses on improving the health of the aging HIV population. Her prior research has explored the impact of chronic disease on persons living with HIV. She has recently extended her work to the evaluation of dementia in the context of HIV infection. Mounting evidence suggests that people aging with HIV experience a unique trajectory of cognitive decline despite treatment with antiretroviral therapy. This may be due to the combined effects of HIV-mediated inflammation and non-HIV factors such as substance use, psychiatric comorbidity, and cardiovascular disease. As many people with HIV in the U.S. are now over 50 years old, age-associated dementias will become an increasingly critical health concern. To date, few studies have characterized dementia in older individuals with well-controlled HIV infection. The proposed research aims to: 1) quantify the contribution of sociodemographic, behavioral, and comorbidity-related factors to risk of dementia in people aged 50+ years with HIV compared to those without HIV, 2) develop and validate a model to predict incident dementia in people with HIV, using electronic health record data and incorporating HIV-specific factors such as HIV infection severity and duration, and 3) develop strategies to optimize the clinical utility of a dementia prediction model. A major strength of the proposed research is that initial model development and validation will be conducted within a large healthcare system with a well-characterized older population with HIV and stable, longitudinal follow-up. This will be followed by validation in an external HIV cohort to assess generalizability, development of a prototype clinician- facing risk stratification tool, and stakeholder interviews to obtain input on future clinical implementation. Novel components of the research include characterization of dementia risk in a community-based sample of people with HIV, comparison with HIV-uninfected individuals from the same setting, and use of advanced analytics to evaluate multiple longitudinal predictors of dementia using primary care data in electronic health records. To support the proposed research and Dr. Lam’s goal of future independent research in HIV and dementia, this K01 proposal includes a formal, mentored training program to develop skills in: 1) the evaluation of risk factors for neurocognitive disorders in people with HIV, 2) analytic modeling techniques for development and validation of electronic health record data-based dementia prediction models, 3) translation and implementation of research findings into clinical care settings, and 4) professional skills development. Trainings will consist of coursework and tailored tutorials delivered by a mentorship team with combined expertise in HIV, neurology, aging, biostatistics, and healthcare delivery science. The results of the proposed research will inform strategies for dementia prevention in people with HIV and support plans to implement and test a dementia risk stratification tool in clinical practice. It will also prepare Dr. Lam for a career as an independent investigator conducting NIH-funded research on prevention and management of dementia in people with HIV.