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Treated people living with HIV show poorer cognitive performance at baseline but similar longitudinal changes over two years compared to appropriately chosen controls
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Reported by Jules Levin
EACS - 16th European AIDS Conference, October 25-27, 2017. Milan
D. De Francesco1, C.A. Sabin1, M. Gisslén2, N.A. Kootstra3, F.W. Wit3,4, J. Schouten3, G.J. Geurtsen3, B. Schmand3, P. Portegies3, D. Fuchs2, H. Zetterberg2, P. Reiss3,4 and A. Winston5 for the ComorBidity in Relation to AIDS (COBRA) Collaboration
1UCL, UK
2University of Gothenburg, Sweden
3AMC, Netherlands
4Stichting HIV monitoring, Netherlands
5Imperial College London, UK
from Jules: this study follows patients for only 2 years and reports below that a non statistically significant 106% in HIV+ & 56.5% in HIV- decline in cognitive function. Two years is short time over which to evaluate cognitive function particularly in that in this group the average age is only 57. I feel that once HIV+ reach over around 63-65 a more steep decline in immunity & cognitive impairment sets in for HIV+ in general, but there will be a significant size group who may see more decline compared to others depending on many factors. But i am convinced cognitive impairment evolves & worsens as HIV+ ages over 63-65.
Several studies were published this past summer on this subject supporting that brain, neurologic, cognitive impairment worsens with aging in HIV+
HIV prematurely ages the brain - new study & Commentary - (07/19/17) -
"Effect of ageing on neurocognitive function by stage of HIV infection: evidence from the Multicenter AIDS Cohort Study"
In an Article in The Lancet HIV,1 Karl Goodkin and colleagues answer the controversial question of whether chronic HIV infection leads to premature ageing in the combination antiretroviral therapy (ART) era: it does.
"5086 participants (47 886 visits) were included in the analytic sample (2278 HIV-seropositive participants contributed 20 477 visits and 2808 HIV-seronegative control participants contributed 27 409 visits)......Deleterious interaction effects were also noted in the domains of episodic memory (p=0⋅03) and motor function (p=0⋅02)......Older age was significantly associated with lower performance in all five neuropsychological domains tested (working memory, episodic memory, motor function, executive function, and information processing speed; p<0⋅0001 for all comparisons)...... results should spur the development of geriatric medicine into an integrated multidisciplinary model of care for ageing patients with HIV.....large studies are needed to address whether ageing people with HIV are at increased risk of age-associated neurodegenerative disorders, such as vascular cognitive impairment6, 7 and perhaps Alzheimer's disease.....results support the general clinical need to screen HIV-infected individuals for HIV-associated neurocognitive disorders and to do so particularly intensively for older HIV-infected individuals, ideally with tests sensitive to deficits in the episodic memory and motor domains"
A greater than expected effect of ageing on episodic memory and motor function with advanced stages of HIV infection suggests that these two domains are most susceptible to the progression of neurocognitive impairment caused by ageing in individuals with HIV. This deficit pattern suggests differential damage to the hippocampus and basal ganglia (specifically nigrostriatal pathways). Older individuals with HIV infection should be targeted for regular screening for HIV-associate neurocognitive disorder, particularly with tests referable to the episodic memory and motor domains.......results should spur the development of geriatric medicine into an integrated multidisciplinary model of care for ageing patients with HIV.....most patients are older than 50 years.....studies have not accounted for - the age-duration effect
Progressive Brain Atrophy Despite Persistent Viral Suppression in HIV Over Age 60 - (07/19/17)
"In summary, we find that long-term virally suppressed HIV-infected individuals have brain atrophy rates that exceed that expected from healthy controls. These results inform a potential gap in neuroprotection despite adherence to cART with long-term maximal viral suppression in plasma."
By virtue of the older age of our study participants compared to other studies, they may be particularly vulnerable to faster changes in brain atrophyas age-associated brain atrophy rates do not appear to have linear slopes in healthy aging.42 Furthermore, our data examined participants in age over 60 years, surpassing age set points thought to represent the 'tipping point' from linear to faster atrophy in presumed healthy aging. For example, a study of 1100 healthy elders noted nonlinear atrophy trajectories dominate in most subcortical regions after age 60 years.3
Cerebellar atrophy, white matter degeneration, and diffuse granule cell loss has been observed in postmortem studies of HIV-infected patients with cerebellar degeneration, cerebellar dysfunction, and gait ataxia.45
"The mean age of study participants was 63 years.....There is controversy as to whether plasma viral suppression is sufficient to halt detrimental brain changes with some arguing that volumetric reductions described in HIV are due to past injury. This study was designed to test whether plasma viral suppression is sufficient to halt progressive atrophy in older HIV-infected participants
In longitudinal ROI models adjusted for age and sex, we uncovered progressive atrophy in the HIV-infected group exceeding rates seen among healthy controls (Table 2, bottom panel) with faster annualized rates of progressive atrophy in the cerebellum (0.42% vs 0.02%, p=0.016), caudate (0.74% vs 0.03%, p=0.012), frontal lobe (0.48% vs 0.01%, p=0.034), total cortical gray matter (0.65% vs 0.16%, p=0.027), brainstem (0.31% vs 0.01%, p=0.026), and pallidum (0.73% vs 0.39%, p=0.046) (Figure 1)......We add to a growing number of studies identifying detrimental neuropathogenic pathways, typically associated with persistent inflammation.
Most of our participants were infected with HIV in the 1980s, before cART was accessible, thus may differ from younger cohorts in brain vulnerability or survivor tendencies."
[ life expectancy is worse in HIV+: AGING CRISIS: Comorbidities Shorten Life & HALE: Healthy Years of Life Expectancy - (05/02/17)]
Mental Health in Aging with HIV - Suicide Ideation Will Increase in Aging Older HIV+ - Successful aging and the epidemiology of HIV - (07/19/17)
New HIV Drugs, Aging, Life Expectancy - (07/26/17)
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