Effects of age, HIV, and HIV-associated clinical factors on neuropsychological functioning and brain regional volume in HIV+ patients on effective treatment

Natalia Gawron,A Pluta,A Horban,S M Rao,A Desowska,E Firląg-Burkacka,B Szymańska-Kotwica,M Sobańska,A R Egbert,E Łojek,T Wolak,M Choiński,H Sienkiewicz-Jarosz,B Biswal,A Scińska-Bieńkowska,P Bieńkowski,R Bornstein

doi:10.1007/s13365-018-0679-4

Abstract

It is yet unclear if people infected with human immunodeficiency virus (HIV+) on stable, combined antiretroviral therapies (cARTs) decline with age at the same or greater rate than healthy people. In this study, we examined independent and interactive effects of HIV, age, and HIV-related clinical parameters on neuropsychological functioning and brain regional volume in a sizable group of Polish HIV+ men receiving cART. We also estimated the impact of nadir CD4 cell count, CD4 cell count during participation in the study, duration of HIV infection, or duration of cART along with age. Ninety-one HIV+ and 95 control (HIV−) volunteers ages 23–75 completed a battery of neuropsychological tests, and 54 HIV+ and 62 HIV− of these volunteers participated in a brain imaging assessment. Regional brain volume in the cortical and subcortical regions was measured using voxel-based morphometry. We have found that HIV and older age were independently related to lower attention, working memory, nonverbal fluency, and visuomotor dexterity. Older age but not HIV was associated with less volume in several cortical and subcortical brain regions. In the oldest HIV+ participants, age had a moderating effect on the relationship between the duration of cART and visuomotor performance, such as that older age decreased speed of visuomotor performance along with every year on cART. Such results may reflect the efficacy of cART in preventing HIV-associated brain damage. They also highlight the importance of monitoring neuropsychological functioning and brain structure in HIV+ patients. This is particularly important in older patients with long adherence to cART.

Highlights

Due to combination antiretroviral therapy, human immunodeficiency virus (HIV) infection has become a manageable, chronic illness and many HIV+ patients reach advanced age
We depict the research evidence showing the influence of HIV infection, age, and HIV-associated clinical factors on neuropsychological performance and brain volume in HIV-positive (HIV+) Polish men receiving combined antiretroviral therapies (cARTs)
There were no significant differences in age, years of formal education, and Mini-Mental State Examination (MMSE) between HIV+ and HIV− groups or between MRI HIV+ and HIV− subgroups

Summary

Introduction

Due to combination antiretroviral therapy (cART), human immunodeficiency virus (HIV) infection has become a manageable, chronic illness and many HIV+ patients reach advanced age. In Europe, the proportion of individuals presenting several years after being infected is high among people older than age 50 (ECDC/WHO 2017). A significant proportion of new diagnoses are being made in this age group (Tavoschi et al 2017). Studies suggest that HIV may continue to affect the brain even in the presence of cART. The impact of the infection on the aging brain structure and cognitive functioning is not yet fully understood. We depict the research evidence showing the influence of HIV infection, age, and HIV-associated clinical factors on neuropsychological performance and brain volume in HIV-positive (HIV+) Polish men receiving cART

Methods

Results

Conclusion