Mechanisms of Cognitive Aging in the HIV-Positive Adult

Abstract

Purpose of Review As of the year 2016, an estimated 50% of the United States' HIV-Positive population is aged 50 years or older. Due to a combination of increased rates of infection in older adults, and successful anti-retroviral (ART) regimens allowing HIV-positive adults to survive for decades with the disease, we are now faced with a steadily graying HIV-positive population, with only limited knowledge of how the cognitive and physiological effects of aging intersect with those of chronic HIV-infection. Recent Findings Age-related changes to mood, cognition, and neurological health may be experienced differently in those living with HIV, and research concerning quality of life, mental health, and cognitive aging needs to account for and explore these factors more carefully in the coming years. Summary This review will explore the topic of cognitive aging with HIV: 1. Central nervous system (CNS) infection of HIV and how the virus affects brain integrity and function; 2. Cognitive and behavioral symptoms of HIV-Associated Neurocognitive Disorders (HAND); 3. Neurobiological theories of Cognitive Aging and how these processes may be exacerbated by HIV-infection; 4: Clinical implications and complications of aging with HIV and factors that may result in poorer cognitive outcomes.

Prefrontal gating of sensory input differentiates cognitively impaired and unimpaired aging adults with HIV

“…Future studies should focus on teasing apart these inter-related constructs. To close, about half of the PLWH in the United States are over 50 years old ( Kamkwalala and Newhouse, 2017 ), and this number is expected to grow. Thus, investigations of aging phenotypes, and mechanisms of cognitive and accelerated aging are paramount to increase our understanding of neural processing and cognitive decline in neuroHIV.…”

“…HIV-associated neurocognitive impairment remains a major concern in those infected with HIV, despite the availability of combination antiretroviral therapy ( Antinori et al , 2007 ; Robertson et al , 2007 ; Cysique and Brew, 2009 ; Heaton et al , 2010 , 2011 ; Lerner et al , 2020 ). Notably, 35–70% of all persons living with HIV (PLWH) develop some form of cognitive impairment ( Robertson et al , 2007 ; Heaton et al , 2010 , 2011 ; Simioni et al , 2010 ; Saylor et al , 2016 ), and with an aging HIV-infected population, this figure will likely remain high or even increase over the next decade ( Kamkwalala and Newhouse, 2017 ). Currently, there are no specific biomarkers that distinguish cognitive impairment amongst PLWH.…”

The age-related trajectory of visual attention neural function is altered in adults living with HIV: A cross-sectional MEG study

“…Such cognitive impairments impinge on activities of daily living and sharply lower the quality of life in PWH [11] , [12] , [13] , [14] , [15] . In addition, at least some PWH exhibit so-called accelerated or pathological ageing relative to their uninfected peers [16] , [17] , [18] , [19] , [20] , which can lead to increased age-related comorbidities affecting both the CNS and peripheral organ systems [21] , [22] , [23] , [24] .…”

Antiretroviral therapy improves neurocognitive impairment in people living with HIV? A meta-analysis

“…The risks of NCI increase with age and may be more notable in PLWH. Moreover, the interaction between aging and the impaired immune response caused by HIV leads to a premature and persistent inflammatory state that could accelerate cognitive changes [ 16 , 20 , 21 ]. The process of cognitive impairment is reflected by biomarkers, such as CD4 cell count [ 22 , 23 ].…”