The effects of HIV and aging on brain functions: proposing a research framework and update on last 3 years' findings

The effect of HIV and aging on brain functions is an increasingly important topic of research: HIV-infected (HIV+) persons aged ≥50 represent a growing part of the HIV epidemic. Research is embracing this new axis, but there has been a lack of conceptualization of the factors that are at stake in both aging and HIV. To start to remedy this theoretical limitation, we are proposing a research framework in the hope that it will optimize how research questions and findings are formulated. Moreover, in the light of this proposed research framework, we review the last 3  years' research findings.

Our review highlights that as HIV+ persons are aging, there is some signal for acceleration of normal aging processes and facilitated expression of age-associated diseases. Evidence for dramatic neurodegeneration in aging HIV+ persons remains limited and may be different in nature to typical neurodegenerative processes. Also, it should be kept in mind that most HIV+ persons are still below age 60. The vast majority of studies are still cross-sectional thereby underlining the critical importance of longitudinal studies to fully assess the effect of comorbidities.

The complex effects of aging and nonaging comorbidities and key HIV effects (as opposed to only HIV status) need to be taken into account in future research by increasing sample size and selecting the most appropriate control group(s). Ideally, life-span studies should be established using neuropsychological and neuroimaging outcomes that have a proven track record in both HIV-related brain injury and brain aging. These would be similar to those that exist in non-HIV aging research and would optimally account for comorbidity effects and survivor bias.