Twelve-year neurocognitive decline in HIV is associated with comorbidities, not age: a CHARTER study

Robert K. Heaton, Ronald J. Ellis, Bin Tang, Christina M. Marra, Leah H. Rubin, David B. Clifford, J. Allen Mccutchan, Benjamin B. Gelman, Susan Morgello, Donald R. Franklin, Scott L. Letendre

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Modern antiretroviral therapy (ART) has increased longevity of people with HIV and shifted the age distribution of the HIV pandemic upward toward that of the general population. This positive development has also led to concerns about premature and/or accelerated neurocognitive and physical ageing due to the combined effects of chronic HIV, accumulating comorbidities, adverse effects or possible toxicities of ART and biological ageing. Here we present results of comprehensive assessments over 12 years of 402 people with HIV in the CNS HIV ART Effects Research (CHARTER) programme, who at follow-up were composed of younger (<60 years) and older (≥60 years) subgroups. Over the 12 years, ART use and viral suppression increased in both subgroups as did systemic and psychiatric comorbidities; participants in both subgroups also evidenced neurocognitive decline beyond what is expected in typical ageing. Contrary to expectations, all these adverse effects were comparable in the younger and older CHARTER subgroups, and unrelated to chronological age. Neurocognitive decline was unrelated to HIV disease or treatment characteristics but was significantly predicted by the presence of comorbid conditions, specifically diabetes, hypertension, chronic pulmonary disease, frailty, neuropathic pain, depression and lifetime history of cannabis use disorder. These results are not consistent with premature or accelerated neurocognitive ageing due to HIV itself but suggest important indirect effects of multiple, potentially treatable comorbidities that are more common among people with HIV than in the general population. Good medical management of HIV disease did not prevent these adverse outcomes, and increased attention to a range of comorbid conditions in people with HIV may be warranted in their care.

Original languageEnglish
Pages (from-to)1121-1131
Number of pages11
JournalBrain
Volume146
Issue number3
DOIs
StatePublished - Mar 1 2023

Keywords

  • HIV
  • brain
  • cognition
  • neurologic complications

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