Social determinants of health were found to be associated with brain aging among patients with HIV infection, according to results of a retrospective case-control study published in The Lancet HIV.
Researchers at Washington University School of Medicine pooled data for this study from several studies conducted at their center between 2008 and 2022. In this study, the effects of comorbidities and adverse social determinants of health on brain aging were evaluated among patients with and without HIV infection. Patients underwent magnetic resonance imaging, and brain age was predicted using DeepBrainNet, a publicly available machine learning algorithm designed to estimate brain-predicted age. Variables associated with brain-age gap, defined as the difference between brain-predicted age and chronologic age, were determined as a function of clinical, comorbid, and social factors via linear regression.
Among patients with (n=379) and without (n=259) HIV infection, the mean (SD) age was 44.8 (15.5) and 38.3 (17.1) years (P <.0001), 78% and 50% were men (P <.0001), 69% and 56% were Black (P =.0021), and they had obtained mean (SD) of 13 (2) and 14 (2) years of education (P <.0001), respectively.
Patients with vs without HIV infection were more likely to be unemployed, have higher 10-year Framingham risk scores, live in areas with greater socioeconomic disadvantage, and experience more early-life stress events. Patients with HIV infection also were more likely to have lower Wide Range Achievement Test (WRAT)-III reading scores and report previous use of alcohol, cocaine, and tobacco (all P ≤.015).
Among HIV-positive patients, 78% had an undetectable viral load, the mean nadir CD4+ T-cell count was 224.3 cells/μL, and 7% had Hepatitis C virus (HCV) coinfection.
The predicted mean absolute error brain age among patients with and without HIV infection was 5.8 and 5.5 years, respectively.
A greater brain-age gap was correlated with smaller brain volumes in the cerebrospinal fluid compartments (r range, 0.15-0.52) and T1 white matter hyperintensities among HIV-positive patients (r, 0.36).
In HIV-positive patients, the brain-age gap was negatively associated with unemployment status (P =.0019), detectable viral load (P =.0023), Framingham score (P =.0034), HCV coinfection (P =.0065), WRAT score (P =.016), CD4 cell count (P =.025), and educational duration (P =.033).
The best-fit model for the brain-age gap in patients with HIV infection included HCV (β, 3.90; P =.073), unemployment status (β, 3.21; P =.020), and Framingham score (β, 1.43; P =.0019). For control patients, the best-fit model included alcohol use (β, 0.40; P =.0041), unemployment status (β, 0.327; P =.79), WRAT score (β, -0.304; P <.0001), and early-life stress events (β, -3.27; P =.047).
The best-fit model for the combined cohort included HCV (β, 3.84; P =.037), male sex (β, 2.11; P =.078), Framingham score (β, 1.06; P =.0039), Area Deprivation Index (β, 0.684; P =.033), alcohol use (β, 0.224; P =.090), and unemployment status (P =.00010).
Overall, the best-subsets model predicted the brain-age gap with a root-mean-square error of 6.72 years.
These study findings may have been limited by the use of pooled data collected over a long time period.
“Taken together, these results pain a nuanced picture of ageing with HIV,” the researchers concluded.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Petersen KJ, Lu T, Wisch J, et al. Effects of clinical, comorbid, and social determinants of health on brain ageing in people with and without HIV: a retrospective case-control study. Lancet HIV. Published online February 7, 2023. doi:10.1016/S2352-3018(22)00373-3