Preventing Neurocognitive Decline in Adults Aging with HIV: Implications for Practice and Research

Abstract

Mild to moderate forms of neurocognitive impairment persist among people living with HIV (PLWH), despite being virally suppressed on antiretroviral therapy. PLWH are disproportionally impacted by physiological and psychosocial comorbidities compared to those without HIV. As adults live longer with HIV, the neurocognitive burden of physiological and psychosocial stressors can impair everyday functioning and may contribute to the development of neurodegenerative diseases such as Alzheimer’s disease. This article outlines neurocognitive consequences of everyday stressors in PLWH. While some lifestyle factors can exacerbate inflammatory processes and promote negative neurocognitive health, novel interventions including the use of cannabinoids may be neuroprotective for aging PLWH who are at risk for elevated levels of inflammation from comorbidities. Studies of integrated neurocognitive rehabilitation strategies targeting lifestyle factors are promising for improving neurocognitive health, and may over time, reduce the risk of Alzheimer’s disease in PLWH.

Neuro‐HIV—New insights into pathogenesis and emerging therapeutic targets

“…However, we believe that the explanations for these differences can be provided within the proposed hypothesis, and there is no need to look for new ideas. Further, as mentioned above, PLWH are disproportionally affected by many physiological and psychosocial factors, 154 which may not be caused by Nef and can modify known pathogenic pathways and mechanisms, resulting in a very complex and variable presentation of this disease.…”