The Neurocognitive Effects of Aging with HIV
Effects of combination antiretroviral therapy along with HIV-induced inflammation, lifestyle, and physical and mental comorbidities have all played a role in neurocognitive issues that people living with HIV (PLWH) face. Advancements in treatment for HIV have enabled PLWH to live long lives and by 2030, an estimated 70% of PLWH will be 50 years or older. Unfortunately, there have been many cases where PLWH develop cognitive impairments because of accelerated normal aging. These impairments can present difficulties in receiving HIV care. More than 50% of PLWH who are 50 years and older meet the criteria for HIV-associated neurocognitive disorder, making those aging with HIV far more vulnerable to cognitive impairments.
There are various methods to improve cognitive function for individuals aging with HIV. Studies have shown that individuals who engage in 10-20 hours of cognitive exercise strengthen the efficiency of cognitive processing. Studies have shown that cognitive training for PLWH can help improve cognitive ability in different domains, such as working memory, attention, and processing speed. In addition, physical activity can improve cognitive functioning. Multiple cross-sectional studies have shown that an increased amount of physical activity is associated with improved cognitive function and daily functioning in PLWH.
There is speculation that healthy diets, such as the ketogenic diet, that help to prevent and mitigate the effects of certain comorbidities, including diabetes, heart disease, and renal disease can help protect the brain health of individuals aging with HIV. Research shows that a reduction in carbohydrates and sugars can help decrease neuroinflammation, which protects brain health and cognition.
As of right now, there is no medical treatment for HIV-Associated Neurocognitive Disorders (HAND). Though, there is some evidence that certain medications that help reduce inflammation may be effective in mitigating the effects of HAND. For example, studies have shown that individuals receiving paroxetine, a selective serotonin reuptake inhibitor antidepressant, have displayed cognitive improvement, suggesting that taking this medication may mitigate oxidative stress-mediated neuronal injury, and therefore may have neuroprotective effects.
As technological advances increase in the future, there is hope that cognitive impairment relating to aging with HIV will be improved as well. Neurofeedback devices, combined with other clinical interventions, can detect cognitive impairment and evaluate treatment efficacy in real time. Software can analyze data to make clinical information easier to interpret and can be integrated with telehealth technology to provide individualized patient care.
In the United States and dependent areas in 2018, nearly 51% of people living with HIV were 50 years and older (CDC, 2018); by 2030, 70% of PLWH will be 50 years and older (Wing, 2016).
In a study with 1,555 PLWH from the CNS HIV Antiretroviral Therapy Effect Research cohort, approximately 30%–50% had HIV-Associated Neurocognitive Disorders, with 21%–30% having ANI asymptomatic neurocognitive impairment, 5%–20% having mild neurocognitive disorder, and 2% having HIV-associated dementia (Heaton et al., 2010).
People aged 50 and older accounted for 17% of the 37,968 new HIV diagnoses in 2018 in the United States and dependent areas (HIV.gov).
In 2019, 92.2% of clients aged 50 and older receiving RWHAP HIV medical care were virally suppressed, which was higher than the national RWHAP average (88.1%) (HIV.gov).
According to CDC, in 2018, 35% of people aged 50 and older already had late-stage HIV infection (AIDS) when they received a diagnosis (i.e., they received a diagnosis later in the course of their disease) (HIV.gov).