Summary
Background
The demography of the HIV epidemic in the United States has shifted toward older age. The objective of this study was to determine the relationship between the processes of aging and HIV infection on neurocognitive impairment.
Methods
We examined the impact of aging, HIV infection (by disease stage), and their interaction across five neurocognitive domains: information processing speed, executive function, episodic memory, working memory, and motor function. Longitudinal data from the Multi- Center AIDS Cohort Study were analyzed to address this question utilizing control for duration of serostatus (in a sub-analysis) as well as controls for other factors affecting cognition Analyses were by linear mixed models for longitudinal data.
Findings
There was a total of 5,086 participants (47,886 visits) in the analytic sample (2,278 were HIV-seropositive participants contributing 20,477 visits; 2,808 were HIV-seronegative control participants contributing 27,409 visits). Direct negative effects of HIV disease progression and aging were observed on all neurocognitive domains. Deleterious interaction effects were also observed in the domains of episodic memory and motor function.
Interpretation
Evidence for a greater than expected impact of aging was found on episodic memory (p=.03) and motor function (p=.02) with advanced stages of HIV infection. This suggests that these two domains are most susceptible to the progression of neurocognitive impairment due to aging amongst the HIV infected. This deficit pattern suggests differential damage to the hippocampus and basal ganglia, specifically nigrostriatal pathways. Older people with HIV infection should be targeted for regular screening for HIV-associated neurocognitive disorder, particularly with tests referable to the episodic memory and motor domains.
Funding
This work was supported by R03 MH086131 awarded to Dr. Goodkin from the National Institute of Mental Health.