Research finds ‘reassuring’ cognitive data for people with HIV

Jolyon Attwooll

17/01/2023 3:57:44 PM

A study has found people on stable HIV treatment mirror normal severe cognitive decline patterns, but suggests vulnerability to subtle declines.

Older woman with red ribbon
Abrupt cognitive decline is very rare among people with HIV, but some people do remain at risk of cognitive health vulnerabilities.

Severe cognitive decline among people with HIV on stable viral suppression treatment follows a similar pattern to the wider population, researchers at UNSW have found.
The results of a study conducted by the team, who tracked 457 participants from 17 healthcare facilities, was published in the most recent edition of the eClinicalMedicine journal.
As part of the study, participants took part in cognitive assessments at 12 months and 24 months, in which 6% and 7% of people showed significant cognitive decline respectively.
‘We observed that statistically significant cognitive decline rates in this virally suppressed people with HIV [PWH] sample are low and not different from what is normally expected,’ the study concluded.  
Authors describe the finding as ‘reassuring to millions of PWH’.
‘These low cognitive decline rates are probably afforded by the ongoing viral suppression among the participants,’ the study stated.
‘While previous studies have also reported that lower viral load reduces the risk for cognitive decline, we are the first to provide a clear epidemiological figure.’
For the authors, the research ‘further highlights the importance of early treatment and achieving and maintaining viral suppression not only for physical health but also for cognitive health’.
However, the study highlighted ‘concerning signals’ that participants’ cognitive health may remain vulnerable, with research also finding 31% of participants showed subtle cognitive decline after assessment at month 12, and 25% at month 24.
According to the authors, this ‘may be related to ongoing subtle brain changes among PWH despite viral suppression’.
‘Our group has previously demonstrated that despite viral suppression, there are signs of progressing subtle brain damage among PWH characterised by abnormal cellular energy, neuronal and axonal injury and restricted neuro-inflammation,’ they wrote.
Associate Professor Lucette Cysique from the UNSW School of Psychology led the team conducting the research, and said that there had previously been contradictory evidence on the risks of significant cognitive decline for people with HIV.
‘Our study resolves some of the contradictions in the literature and provides a clearer message to doctors and people with HIV,’ she said.
‘And while it clarifies that abrupt cognitive decline is very rare, some people with HIV do remain at risk of cognitive health vulnerabilities that may develop slowly.’
Along with HIV status, the researchers also considered demographic and socioeconomic factors, healthcare-seeking behaviours and health status.
Among possible factors affecting cognitive decline are the direct effects of HIV, the indirect impact of increased comorbidities, and the influence of mental health and alcohol and drug use disorders.
Participants in a regular relationship, as well as those with excellent English, and who avoided perceived stigma were associated with higher cognitive scores. Reliance on government subsidies, severe depression, and lower belief in antiretroviral treatment were factors associated with lower scores.
The authors said further neuroimaging studies are needed and suggested that as people with HIV age, cognitive health should be prioritised.
‘In practical terms, it means that greater resources should start to be allocated to ageing PWH to provide multi-disciplinary services integrating physical, mental, and cognitive healthcare,’ the study states.
The authors also recommend expanding psychosocial services and peer-support strategies given the negative influence of loneliness and financial difficulties.
‘Like any chronic condition that demands a life-long treatment, it’s important for us to determine whether people with HIV may require extra care as a result of mental and cognitive health changes as they reach their 60s,’ Associate Professor Cysique said.
She encourages people with HIV who notice signs of mild cognitive decline to discuss the issue with a trusted doctor.
‘Cognitive and mental health are sensitive topics in a population that has been and remains stigmatised,’ she said.
‘Historically, research has emphasised the importance of having an undetectable viral load.’
Associate Professor Cysique also said she would like to see cognitive decline prevention strategies adapted and developed for people with HIV.
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