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Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty
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Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

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HIV, aging, and cognition: emerging issues

Victor G Valcour1

  • 1Department of Neurology, Division of Geriatric Medicine, University of California San Francisco, San Francisco, CA, USA.

Topics in Antiviral Medicine
|August 29, 2013
PubMed

Insights

HIV-associated neurocognitive disorder remains prevalent at 50%, with mild neurocognitive disorder more common than dementia. Age and specific genetic factors like ApoE4 influence cognitive impairment in older adults on antiretroviral therapy.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Geriatrics

Background:

  • HIV-associated neurocognitive disorder (HAND) prevalence remains high at 50% despite potent antiretroviral therapy (ART).
  • Mild neurocognitive disorder (MND) and asymptomatic neurocognitive impairment (ANI) are now more frequent than HIV-associated dementia.
  • The distinction between ANI and MND is often blurred due to comparable functional deficits and neuropsychological testing abnormalities.

Purpose of the Study:

  • To examine correlates of cognitive impairment in older adults with HIV.
  • To investigate the impact of age-related comorbidities on cognitive function in HIV-infected individuals.
  • To inform management strategies for cognitive impairment in the context of effective ART.

Main Methods:

  • Analysis of a cohort of patients aged 60 years or older with excellent ART adherence.
  • Assessment of cognitive impairment using neuropsychological testing.
  • Evaluation of correlates including apolipoprotein (Apo) E4 genotype, monocyte efficacy (ME) score, diabetes, and nadir CD4+ cell count.

Main Results:

  • Apolipoprotein (Apo) E4 genotype and monocyte efficacy (ME) score were significant correlates of cognitive impairment in older adults with HIV.
  • Diabetes and nadir CD4+ cell count showed trend associations with cognitive impairment.
  • Age-related comorbidities exacerbate cognitive impairment risk in HIV-infected individuals.

Conclusions:

  • Cognitive impairment in older adults with HIV is associated with ApoE4 genotype and ART effectiveness at the cellular level (ME score).
  • Management should focus on optimizing ART, adherence, and addressing comorbidities like diabetes.
  • Switching ART for mild cognitive impairment is generally not recommended but requires individualized assessment.

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