No Difference in Aging-Related Brain Changes in Patients With Suppressed HIV
Baseline analysis indicated that people living with HIV had significantly lower grey matter volume and greater white matter hyperintensity load compared with HIV-negative control patients.
According to the results of a recent study published in Clinical Infectious Diseases, HIV-positive patients with virological suppression did not have significantly different rates of aging-related brain changes or cognitive decline compared with HIV-negative control patients.
In this longitudinal observational study, 134 people living with HIV and 79 HIV-negative control participants with similar demographic and lifestyle characteristics were included from the Comorbidity in Relation to AIDS (COBRA) project. HIV-positive participants were receiving antiretroviral therapy at baseline and had undetectable plasma HIV RNA for at least 1 year before enrollment. Patients with intravenous drug use, excessive alcohol consumption, and daily recreational drug use (excluding cannabis) were excluded from the study. Comprehensive neuropsychological assessments of cognitive performance and magnetic resonance imaging were performed at baseline and after 2 years.
Baseline global cognitive performance was lower in people living with HIV compared with in control patients (P <.001). Significantly reduced domains of cognitive function at baseline included attention (P <.001), information processing speed (P =.001), executive function (P =.02), and motor function (P <.001). Similarly, compared with control patients, people living with HIV had significantly lower grey matter volume (P =.04) and greater white matter hyperintensity load (P =.02) at baseline.
At 2-year follow-up, changes in cognitive performance were similar between participants with and without HIV for all domains except for increased memory in both groups (P <.001) and reduced attention in the HIV-positive group relative to the HIV-negative group at follow-up (P =.02). Furthermore, both groups had increased mean white matter hyperintensity load, altered white matter structure, and reduced cerebral perfusion, with no significant between-group differences in the rates of change.
Among people living with HIV, the variables of CD4 count, nadir CD4 count, time since HIV diagnosis, antiretroviral therapy duration, or past AIDS diagnosis were not associated with longitudinal brain neuroimaging changes.
In an interview with Infectious Disease Advisor, James Cole, PhD, from the Faculty of Medicine in the Department of Medicine at Imperial College London and lead author on the study, concluded that "when HIV is being suppressed, we don't see differences between HIV-positive and HIV-negative people in terms of longitudinal brain structure and function, suggesting that monitoring adherence to treatment is really important."
Cole JH, Caan MWA, Underwood J, et al; COBRA collaboration. No evidence for accelerated ageing-related brain pathology in treated HIV: longitudinal neuroimaging results from the Comorbidity in Relation to AIDS (COBRA) project [published online January 4, 2018]. Clin Infect Dis. doi: 10.1093/cid/cix1124