Examining the Correlation Between HIV Infection and Cognitive Impairment

^{By Julie Gould} 

According to recent study findings publishing online in Ageing Research Reviews, older adults with HIV infection are at increased risk of cognitive impairment. More specifically, this patient population is more at risk for cognitive impairment within the following domains:  

• executive function;
• processing speed;
• verbal;
• recall; and
• motor/psychomotor.  

To better understand the study design, findings, and clinical implications, we spoke with Han-Zhu Qian, MD, PhD, MPH. Dr Qian explains why it is important to screen cognitive functions and identify the domains of cognitive impairment by age group among people living with HIV. 

Dr Qian, can you talk about why you conducted this study? What data prompted this research?  

Thanks to the wide access to effective HIV treatment, the life expectancy of people living with HIV (PLWH) both in high- and low-income countries has increased in recent years, but PLWH continue to be at a high risk of comorbidity, particularly aging-related chronic diseases.  

One particular concern about aging-related comorbidity among older PLWH (aged 50 years or older) is declining cognitive function. Studies have shown inconsistent results on the relationship between HIV infection and cognitive impairment among older PLWH. Therefore, we conducted a meta analysis to make generalizations across all available evidence at the global scale on HIV and cogntive impairment among older PLWH.

Can you highlight some of the findings of the study? Were any of the outcomes particularly surprising?

Our meta-analysis found that older PLWH were more than twice likely to have cognitive impairment than older adults without HIV infection, specifically in five cognitive domains of executive function, processing speed, verbal, recall, and motor/psychomotor. This difference was not observed in other two domains of visuospatial and working memory/attention.  

The most surprising finding was that the affected domains among older PLWH seem to be different from those among younger age groups. Previous meta-analyses that the most notable deficits in cognitive functioning among all age groups of PLWH were in the domains of motor and attention and in the domains of working memory and processing speed among perinatally-infected children and adolescents living with HIV. It was suggested that the cognitive domains affected by HIV infection may differ by age group.

What are the possible real-world applications of these findings in clinical practice?

One possible application of our study findings is to screen the cognitive functions and identify the domains of cognitive impairment by age group among PLWH; another application is providing cognitive trainings on specific domains for older PLWH.  

Do you and your co-investigators intend to expand upon this research?

Yes, we are planning to develop an online intervention study for screening and ameliorating cognitive deficits among older PLWH.  

What else would you like to add to this conversation? 

Most studies included in our meta-analysis were observational studies. The best evidence on the relationship between HIV infection and cognitive functions would be from intervention trials. Therefore, future research may focus on assessing the effect of clinical interventions on reducing the declining of cognitive functions among PLWH.   

About Dr Qian

Han-Zhu Qian, MD, PhD, MPH, is a research scientist within the faculty of biostatistics at Yale University School of Public Health. His research focuses on epidemiology of infectious diseases and prevention interventions of HIV and sexually transmitted diseases among key and vulnerable populations in global settings. 

Reference:

Deng L, Zhang X, Gao Y, et al. Association of HIV infection and cognitive impairment in older adults: A meta-analysis [published online ahead of print, 2021 Feb 26]. Ageing Res Rev. 2021;68:101310. doi:10.1016/j.arr.2021.101310