Cognitive and Brain Imaging Changes Over Time in Individuals Living with HIV
Overview
This study examined the effects of aging, HIV serostatus, and viral load on cognition and brain volumes in persons with and without HIV. Findings indicate that people with HIV who maintain viral suppression do not experience accelerated cognitive decline or brain volume loss compared to HIV-negative individuals, whereas those with detectable viral loads show steeper cognitive decline and smaller brain volumes.
Background
With effective antiretroviral therapy (ART), people with HIV (PWH) now have life expectancies similar to the general population, reducing severe HIV-associated dementia but not milder neurocognitive impairments. Aging and HIV independently affect cognitive performance and brain structure, but the interaction between these factors remains unclear. Previous studies have been limited by small sample sizes, cross-sectional designs, and lack of HIV-negative controls, especially regarding the impact of viral suppression status. This study addresses these gaps by analyzing a large cohort with longitudinal cognitive and neuroimaging data.
Data Highlights
Group
Participants (n)
Sessions
Viral Load Status
People Without HIV (PWOH)
259
841 total sessions (all groups combined)
Not applicable
People with HIV Undetectable (PWHU)
264
HIV RNA ≤50 copies/mL
People with HIV Detectable (PWHD)
84
HIV RNA >50 copies/mL
Key Findings
PWOH and PWH with undetectable viral loads (PWHU) showed similar cognitive performance changes with age.
PWH with detectable viral loads (PWHD) exhibited a steeper cognitive decline compared to both PWOH and PWHU.
Both PWH groups had significantly smaller regional brain volumes than PWOH, but volume loss slopes with age were similar except in lentiform regions.
Smaller brain volumes combined with increased age were associated with greater cognitive decline in PWHD.
Viral suppression in PWH is associated with no accelerated decline in cognition or brain volumes relative to HIV-negative individuals.
Clinical Implications
Maintaining viral suppression in PWH is critical to prevent accelerated cognitive decline and brain volume loss associated with detectable viral loads. Regular cognitive and neuroimaging monitoring may be particularly important for PWH with detectable viremia to identify and manage accelerated neurocognitive deterioration. These findings support aggressive viral load management as a key strategy in preserving brain health in aging PWH.
Conclusion
This study demonstrates that viral suppression in PWH mitigates accelerated cognitive and brain volume decline seen in those with detectable viral loads, underscoring the importance of effective ART and viral load control in aging individuals living with HIV.
References
Heaton et al. 2024 -- Cognitive and Brain Imaging Changes Over Time in Individuals Living with HIV
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