With successful treatment, HIV has become a chronic health condition that can be managed with lifelong care.
Treatment reduces the amount of HIV in the blood to undetectable levels, and most people with an infection who take drugs live as long as people who are not infected with HIV.
Although viral treatments have been successfully developed, it is important to understand how HIV affects long-term cognitive function in aging people.
Associate Professor Lucette Sijik so Faculty of Psychology, UNSW Sydneyand her team conducted a long-term study of cognitive function in people aging with chronic stable HIV infection from 17 care facilities across Australia, electronic clinical medicine.
The study found that stable HIV-infected people who were on medication were less likely to show significant cognitive decline as they aged. However, there are factors that make people more susceptible to subtle cognitive decline, including poor mental health, social isolation, and declining socioeconomic status.
“As with any chronic disease that requires lifelong treatment, we want to determine whether special care is required as a result of changes in mental and cognitive health status when people with HIV reach their 60s. is important,” says A/Prof. Sisik.
Digging into cognitive data
As a multidisciplinary team, researchers ranging from infectious disease physicians to neuroscientists analyzed the cognitive performance of 457 people living with HIV over a two-year period.
Participants were assessed with a brief cognitive screening test assessing factors such as memory, learning and attention. Beyond cognition, this study evaluated a wide range of information on the psychosocial and socioeconomic determinants of health.
They found that at 12 and 24 months, only 6% and 7% of people showed significant or meaningful cognitive decline, respectively. These figures reflect the general population of the same age (average 51 years plus or minus 12 years).
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However, over the same interval, 31% and 25% of participants showed subtle cognitive changes. This mild cognitive decline may be related to small ongoing changes in the brains of HIV-infected individuals, despite very low levels of HIV in their blood.
The study also found that financial instability, social isolation, and severe depression were associated with cognitive decline.
Pictures of significant cognitive decline so far
Existing research in the area of NeuroHIV paints a blurry picture, says A/Prof. Sisik.
Due to inconsistent methods and data, there is conflicting evidence about whether people with HIV are at risk of significant cognitive decline. This has led to confusing messages for both the community and clinicians.
“Our study resolves some of the contradictions in the literature and provides a clearer message for physicians and people living with HIV,” says Professor A/. Sisik. “We also make clear that sudden cognitive decline is extremely rare, but some of her HIV-infected individuals are at risk for cognitive vulnerabilities that can progress slowly. I have.”
Pay attention to your mental and cognitive health
A/Prof. Cysique and her team recommend that, like everyone aging with chronic disease, special attention should be paid to mental and cognitive health.
“This is the same approach taken by people with type 1 diabetes.
First of all, if there are signs of mild cognitive decline, such as changes in short-term memory or difficulty multitasking, A/Prof. Cysique encourages people to ignore it and not ignore it. increase.
She also stresses that people living with HIV should start this conversation with a trusted doctor. However, continued support for those with low financial support and those who are socially isolated remains important.
“Cognition and mental health have been and continue to be sensitive topics for people who are stigmatized. Historically, research has emphasized the importance of undetected viral load.”
read more: Australia hits record low HIV numbers, but delays in diagnosis raise concerns
Important, but A/Prof. Cysique highlights growing evidence that other aspects of health are just as important, and will become even more so as people living with HIV age.
“To support the aging population living with HIV, Cognitive decline prevention strategy and framework It is available to people all over the world. However, I think these resources need to be adapted and developed for people living with HIV. Because HIV is still stigmatized, doctors need to be HIV-savvy to provide proper care. ”
Future research and collaboration with the community
This research is just one piece of the puzzle to bring the message about cognitive health and people living with HIV into greater focus, especially in Australia. Sisik says. She hopes future research will build on long-term observational studies of people in their 70s and will eventually be combined with intervention studies in which solutions to manage and improve cognitive and mental health will be tested. I hope
Further research is also needed to understand how mild cognitive changes affect daily performance and quality of life.
“We want to move to a holistic approach to care for people aging with HIV, including the provision of cognitive and mental health, stigma-free care. We work closely with researchers, clinicians, and representatives of the HIV community to develop adapted care plans.
“People with HIV have historically been a self-empowered group of patients who have contributed to changing the relationship between physicians, scientists, and patients for the better. It highlights the contribution of patient groups in this area: people living with HIV are thus pioneers and continue to advocate for their care as they age.”
