4.7 Article

Twelve-year neurocognitive decline in HIV is associated with comorbidities, not age: a CHARTER study

Journal

BRAIN
Volume 146, Issue 3, Pages 1121-1131

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/brain/awac465

Keywords

HIV; neurologic complications; cognition; brain

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In a 12-year longitudinal study of over 400 people with HIV, it was found that cognitive decline is not related to chronological age but to comorbidities. This challenges the notion of premature cognitive aging due to HIV and suggests that managing comorbidities could prevent cognitive decline in individuals with HIV.
In a longitudinal study following more than 400 people with HIV (people with HIV) over 12 years, Heaton et al. find that cognitive decline is not associated with chronological age, but with comorbidities. This is inconsistent with premature cognitive ageing due to HIV, and suggests that comorbidity management may prevent cognitive decline in people with HIV. Modern antiretroviral therapy (ART) has increased longevity of people with HIV and shifted the age distribution of the HIV pandemic upward toward that of the general population. This positive development has also led to concerns about premature and/or accelerated neurocognitive and physical ageing due to the combined effects of chronic HIV, accumulating comorbidities, adverse effects or possible toxicities of ART and biological ageing. Here we present results of comprehensive assessments over 12 years of 402 people with HIV in the CNS HIV ART Effects Research (CHARTER) programme, who at follow-up were composed of younger (<60 years) and older (>= 60 years) subgroups. Over the 12 years, ART use and viral suppression increased in both subgroups as did systemic and psychiatric comorbidities; participants in both subgroups also evidenced neurocognitive decline beyond what is expected in typical ageing. Contrary to expectations, all these adverse effects were comparable in the younger and older CHARTER subgroups, and unrelated to chronological age. Neurocognitive decline was unrelated to HIV disease or treatment characteristics but was significantly predicted by the presence of comorbid conditions, specifically diabetes, hypertension, chronic pulmonary disease, frailty, neuropathic pain, depression and lifetime history of cannabis use disorder. These results are not consistent with premature or accelerated neurocognitive ageing due to HIV itself but suggest important indirect effects of multiple, potentially treatable comorbidities that are more common among people with HIV than in the general population. Good medical management of HIV disease did not prevent these adverse outcomes, and increased attention to a range of comorbid conditions in people with HIV may be warranted in their care.

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