Cognitive ageing is premature among a community sample of optimally treated people living with HIV

Abstract

Objectives Evidence of premature cognitive ageing amongst people living with HIV (PLHIV) remains controversial due to previous research limitations including underpowered studies, samples with suboptimal antiretroviral access, varying rate of virological control, high rate of AIDS, over‐representation of non‐community samples, and inclusion of inappropriate controls. The current study addresses these limitations, while also considering mental health and non‐HIV comorbidity burden to determine whether PLHIV showed premature cognitive ageing compared with closely comparable HIV‐negative controls. Methods This study enrolled 254 PLHIV [92% on antiretroviral therapy; 84% with HIV RNA < 50 copies/mL; 15% with AIDS) and 72 HIV‐negative gay and bisexual men [mean (SD) age = 49 (10.2) years] from a single primary care clinic in Sydney, Australia. Neurocognitive function was evaluated with the Cogstate Computerized Battery (CCB) at baseline and 6 months after. Linear mixed‐effects (LME) models examined main and interaction effects of HIV status and chronological age on the CCB demographically uncorrected global neurocognitive z‐score (GZS), adjusting for repeated testing, and then adjusting sequentially for HIV disease markers, mental health and comorbidities. Results HIV status and age interacted with a lower GZS (β = −0.43, P < 0.05). Higher level of anxiety symptoms (β = −0.11, P < 0.01), historical AIDS (β = −0.12, P < 0.05) and historical HIV brain involvement (β = −0.12, P < 0.05) were associated with lower GZS. Conclusions We found a robust medium‐sized premature ageing effect on cognition in a community sample with optimal HIV care. Our study supports routine screening of cognitive and mental health among PLHIV aged ≥ 50 years.

Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016

“…Our finding that ART-treated PWH had higher incidence and prevalence of dementia than PWoH across all time periods is consistent with growing evidence that cognitive aging may be premature and/or accelerated among PWH [35][36][37][38][39][40][41][42]. These results also align with a recent study within an independent KP Northern Californian cohort from 2013 to 2019, which found elevated dementia risk among ART-treated PWH compared with demographically matched uninfected PWoH, even after controlling for traditional dementia risk factors [27].…”

Sleep disturbances in HIV infection and their biological basis

“…HAND is an umbrella term which encompasses diseases of growing severity including asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia (HAD). Whilst the incidence of the most severe forms has fallen, prevalence of milder neurocognitive impairments remains comparable to the pre-ART era [58].…”

Low incidence of advanced neurological burden but high incidence of age-related conditions that are dementia risk factors in aging people living with HIV: a data-linkage 10-year follow-up study

“…At baseline (2011–2012), their neurocognitive functioning, mental health and HIV, and general health were assessed. The baseline data have been published (Aung et al 2021b ; Bloch et al 2016 ; Kamminga et al 2017 ). We observed that premature aging among PLHIV compared to HIV-negative controls was associated with worse neurocognitive functioning (Aung et al 2021b ).…”

“…The baseline data have been published (Aung et al 2021b ; Bloch et al 2016 ; Kamminga et al 2017 ). We observed that premature aging among PLHIV compared to HIV-negative controls was associated with worse neurocognitive functioning (Aung et al 2021b ). Thus, 10 years later, we had the opportunity to determine the burden of ARC including non-HIV age-related neurological disorders.…”