People living with HIV have increased risk of neurocognitive impairment when they grow older
In the era of highly active antiretroviral treatment, HIV-associated neurocognitive disorders (HAND) still affect people living with HIV as they get older.
People living with HIV face an elevated risk of developing neurocognitive impairment when they get older, even if they are on antiretroviral treatment (ART) and are virally suppressed, a new study suggests.
HIV-associated neurocognitive impairment (HAND) refers to a range of issues that affect the mental functioning (e.g. memory, attention, language, processing speed, sensory perception, motor skills) of a person living with HIV. These are directly linked to their HIV status and are not pre-existing conditions.1
HAND includes HIV-associated dementia (HAD) – which was very common in the pre-highly active antiretroviral therapy (HAART) era. But more common today, are mild neurocognitive disorder (MND) and asymptomatic neurocognitive impairment (ANI). A number of studies have shown that HIV-positive people experience neurocognitive decline more often than the general population.2
The researchers evaluated whether or not advancing age had an impact on neurocognitive decline in 3,300 people living in the USA who were on first-time ART and virally suppressed. The research led by the University of California San Diego and published ahead of print in the journal AIDS is the largest ever to look at the impact of ageing on HAND.
While the initiation of ART can result in significant neurocognitive improvement for people living with HIV, the impact of ageing on HAND has been less well understood. With 50% of people living with HIV now over the age 50, and 30% over the age of 60, studies such as this are increasingly important.
Over the two to nine years that they followed the patients, they found that neurocognitive impairment improved overall as a result of viral suppression through antiretroviral therapy.3 But even after adjusting for the effects of ageing using norms from HIV-negative people, they found that older people living with HIV were more likely to experience neurocognitive impairment – and these odds increased by nearly 20% for each decade they aged.
This suggests that people living with HIV face a significant and increased risk of developing neurocognitive impairment when getting older, even if they are on ART and are virally suppressed.
It identified people to be at a greater risk from their 50s onwards. This is contrary to previous studies which have identified an increased risk from the age of 70 onwards. The analysis found women and people who are Hispanic were more at risk of developing neurocognitive impairment as they aged. Hepatitis C co-infection was also found to be a significant risk factor for poorer neurocognitive outcomes.
The researchers called for further work to be done in this field in order to understand which factors drive neurocognitive impairment for HIV positive people as they age.
Important areas for future analysis include associations with co-infections such as syphilis and cytomegalovirus, and vascular risk factors including diabetes, hypercholesterolemia and obesity. Treatment responses will depend in part on which factors or combinations of these factors are found to be driving neurocognitive impairment in people living with HIV.