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Neuropathologic Findings in Elderly HIV-Positive Individuals
Shino D Magaki1, Harry V Vinters2, Christopher K Williams1
1Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, CA, USA.
Journal of Neuropathology and Experimental Neurology
|June 3, 2022
Summary
Aging with HIV is complex. Elderly individuals on combination antiretroviral therapy (cART) show no increased brain inflammation or Alzheimer
Area of Science:
- Neuroscience
- Gerontology
- Infectious Diseases
Background:
- The growing elderly population with human immunodeficiency virus (HIV) on combination antiretroviral therapy (cART) presents unique aging challenges.
- HIV-associated neurocognitive disorder (HAND) affects a significant proportion of individuals, even with cART, but its underlying mechanisms remain unclear.
- The role of neuroinflammation in accelerated brain aging and increased risk for Alzheimer disease (AD) in HIV is not well understood.
Purpose of the Study:
- To investigate the impact of longstanding HIV infection on brain aging in elderly individuals.
- To compare neuroinflammation and Alzheimer disease pathology between elderly HIV-positive and HIV-negative individuals on cART.
- To explore the association between comorbidities and cognitive function in this aging HIV cohort.
Main Methods:
- Examined brain tissue from 9 elderly HIV-positive subjects on cART (without hepatitis C co-infection) and 7 age-matched HIV-negative controls.
- Assessed microglial and astrocyte activation as markers of neuroinflammation.
- Evaluated Alzheimer disease pathology, including amyloid deposition and neurofibrillary tangles.
- Correlated neuropathological findings with systemic comorbidities and neurocognitive assessments.
Main Results:
- No significant differences in microglial or astrocyte activation were observed between HIV-positive and HIV-negative elderly cohorts.
- Amyloid deposition was present in cognitively normal individuals across both groups; neurofibrillary tangles were sparse in the HIV-positive group.
- Cardiovascular comorbidities were prevalent in all subjects, irrespective of HIV status.
Conclusions:
- Longstanding HIV infection on cART does not appear to accelerate brain aging markers like neuroinflammation or AD pathology in the elderly.
- Cognitive impairment in aging HIV-positive individuals is likely multifactorial, influenced by factors beyond HIV itself.
- Further research is needed to understand the complex interplay of aging, HIV, comorbidities, and cognitive health.
