With successful treatment, HIV has become a chronic health condition that can be carefully managed throughout life.
The treatment reduces the amount of HIV in the blood to an undetectable level, and most infected people who take their medication live as long as people without HIV.
Although there have been successful developments in treating the virus, it is important to understand how it may affect the long-term cognitive function of people aging with HIV.
Associate Professor Lucette Cysique from the School of Psychology, UNSW Sydney, and her team conducted a long-term study of cognitive function in people aging with stable chronic HIV infection from 17 care centers in Australia, published in eClinicalMedicine.
The study found that people with stable HIV infection, who take their medications, are unlikely to show significant cognitive decline as they age. But there are factors that make people more vulnerable to subtle cognitive decline, including poorer mental health, social isolation and lower socioeconomic status.
“Like any chronic disease that requires lifelong treatment, it is important for us to determine whether people with HIV may need additional care as a result of changes in mental and cognitive health as they reach their 60s,” he said. say To/Prof. Cysique says
Exploring data on cognitive performance
Working as a multidisciplinary team, researchers from infectious disease doctors to neuroscientists analyzed the cognitive performance of 457 people with HIV over two years.
Participants were assessed on a short cognitive screening test, which assessed factors such as memory, learning and attention. In addition to cognition, the study assessed a wide range of information on psychosocial and socioeconomic determinants of health.
The results revealed that at 12 months and 24 months, only 6% and 7% of people, respectively, showed significant or significant cognitive impairment. These figures reflect the general population of the same age (an average of 51 years, plus or minus 12).
Read more: People with HIV have a higher risk of aging-related genetic changes
However, during the same intervals, 31% and 25% of participants showed subtle cognitive changes. This slight cognitive decline may be related to small ongoing changes in the brain among people with HIV, despite having very low levels of HIV in their blood.
The study also found that financial instability, social isolation and severe depression were associated with poorer cognitive health.
The picture of significant cognitive impairment so far
Existing studies in the field of NeuroHIV paint a blurry picture, says A/Prof. Cysic.
Because of inconsistencies in methods and data, there has been conflicting evidence about whether there is a significant risk of cognitive impairment in people with HIV. This, in turn, has led to confusing messages for both the community and clinicians.
“Our study resolves some of the contradictions in the literature and provides a clearer message to clinicians and people living with HIV,” says A/Prof. Cysic. “And while it clarifies that sudden cognitive decline is very rare, some people with HIV remain at risk of cognitive health vulnerabilities that can develop slowly.”
Attention to mental and cognitive health
A/Prof. Cysique and her team recommend that, like anyone aging with a chronic illness, extra attention should be paid to their mental and cognitive health.
“It’s the same approach that people who have type 1 diabetes can take. As people age, there needs to be a proactive focus on this type of care, rather than a laissez-faire approach.”
In the first instance, if there is any sign of mild cognitive impairment, such as a change in short-term memory or greater difficulty with multitasking, A/Prof. Cysique encourages people not to ignore it or let it be dismissed.
He also stresses that people with HIV should start this conversation with their trusted doctor. Changes in mental health should also prompt additional attention to cognitive health, while continued support for those with less financial support and those who are socially isolated remains critical.
“Cognitive and mental health are sensitive issues in a population that has been and continues to be stigmatized. Historically, research has emphasized the importance of having an undetectable viral load.”
Read more: Australia records lowest HIV numbers ever, but late diagnoses are worrying
Although significant, A/Prof. Cysique highlights the growing evidence that other aspects of health are just as important, and even more so as people with HIV age.
“To support people with HIV into old age, we would like to see something similar to the cognitive decline prevention strategies and framework that is available to the global population. But I think these resources need to be adapt and develop for people with HIV because there is still some stigma about HIV, and also because doctors need to be knowledgeable about HIV to provide appropriate care.”
Future research and community work
The study is just one piece of the puzzle that hopes to bring messages about cognitive health and people living with HIV, particularly in Australia, into sharper focus, A/Prof. Cysique says He hopes that future research can be based on long-term observational studies in people in their 70s, and eventually combined with intervention studies where solutions are tested to manage and improve cognitive and mental health.
Further studies should also capture how mild cognitive changes may be affecting people’s ability to perform everyday tasks and their quality of life.
“We want to move toward a holistic approach to care for people aging with HIV, one that includes cognitive and mental health and stigma-free care delivery. Our group is currently working with researchers, clinicians, and advocates of the HIV community internationally to develop tailored care plans.
“People with HIV have historically been a self-empowered patient group that has helped change the physician/scientist-patient relationship for the better. Clinical research today emphasizes the contribution of patient groups to research projects. People with HIV pioneered this way and continue to advocate for their care as they age.”