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Effects of clinical, comorbid, and social determinants of health on brain ageing in people with and without HIV: a retrospective case-control study
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Our findings indicate that comorbid and social determinants of health are associated with brain ageing in people with HIV, alongside traditional HIV metrics such as viral load and CD4 cell count, suggesting the need for a broadened clinical perspective on healthy ageing with HIV, with additional focus on comorbidities, lifestyle changes, and social factors.>
Positive brain-age gap (ie, age overestimation) reflects the accumulation of pathology; for example, people with Alzheimer's disease or mild cognitive impairment,9 schizophrenia,10 and HIV11, 12, 13 have higher brain-age gap on average than controls.....studies have largely focused on between-group differences rather than explaining within-group variability. Moreover, they have typically examined the effect of the primary disease rather than the effects of comorbidities and social factors. The aim of this study was to identify current and lifetime factors that explain brain ageing in people with HIV and people without HIV.>
We predicted that cardiovascular risk14 and detectable viral load11 would show positive associations with brain-age gap in people with HIV. On the basis of known relationships between social determinants of health and mortality and morbidity in people with HIV, we predicted that greater neighbourhood socioeconomic deprivation 15 and early life stress16 would correspond to elevated brain-age gap. By contrast, because education is linked with better neuropsychological functioning in people with HIV,17 we predicted an inverse association between education achievement and brain-age gap.>
Our findings indicate that comorbid and social determinants of health are associated with brain ageing in people with HIV, alongside traditional HIV metrics such as viral load and CD4 cell count, suggesting the need for a broadened clinical perspective on healthy ageing with HIV, with additional focus on comorbidities, lifestyle changes, and social factors.>
FindingsInterpretation>
In people with HIV (mean age 44·8 years [SD 15·5]; 78% [296 of 379] male; 69% [260] Black; 78% [295] undetectable viral load), brain-age gap was associated with Framingham cardiovascular risk score (p=0·0034), detectable viral load (>50 copies per mL; p=0·0023), and hepatitis C co-infection (p=0·0065). After variable selection, the final model for people with HIV retained Framingham score, hepatitis C, and added unemployment (p=0·0015). Educational achievement assayed by reading proficiency was linked with reduced brain-age gap (p=0·016) for people without HIV but not for people with HIV, indicating a potential resilience factor. When people with HIV and people without HIV were modelled jointly, selection resulted in a model containing cardiovascular risk (p=0·0039), hepatitis C (p=0·037), Area Deprivation Index (p=0·033), and unemployment (p=0·00010). Male sex (p=0·078) and alcohol use history (p=0·090) were also included in the model but were not individually significant.>
Interpretation>
Our findings indicate that comorbid and social determinants of health are associated with brain ageing in people with HIV, alongside traditional HIV metrics such as viral load and CD4 cell count, suggesting the need for a broadened clinical perspective on healthy ageing with HIV, with additional focus on comorbidities, lifestyle changes, and social factors.
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