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Longitudinal Changes in Cognition and Brain Imaging in Persons With Human Immunodeficiency Virus
James Kennedy1, Sarah A Cooley1, June Roman Fox1
1Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA.
The Journal of Infectious Diseases
|January 16, 2026
Summary
Persons with HIV (PWH) with undetectable viral load show no accelerated cognitive or brain aging compared to those without HIV. However, PWH with detectable virus face higher risks of cognitive decline and brain changes.
Area of Science:
- Neuroscience
- Infectious Diseases
- Gerontology
Background:
- Aging populations of people with HIV (PWH) necessitate understanding HIV's impact on aging and brain health.
- Cognitive disorders in aging PWH are a growing concern, influenced by HIV, aging, and brain integrity.
Purpose of the Study:
- To analyze the effects of aging, HIV serostatus, and viral load on cognition and brain volumes.
- To compare cognitive performance and brain structure changes over time in persons without HIV (PWoH), PWH with undetectable virus (PWHU), and PWH with detectable virus (PHWD).
Main Methods:
- Utilized cross-sectional and longitudinal data from 259 PWoH, 264 PWHU, and 84 PHWD (841 sessions total).
- Assessed cognitive function using composite scores (NPZ4) and measured regional brain volumes.
- Employed generalized additive mixed models to examine age-related changes and interactions on cognition and brain volumes across groups.
Main Results:
- PWH with undetectable virus (PWHU) and PWoH showed similar cognitive aging trajectories; PHWD exhibited steeper cognitive decline.
- Both PWH groups had smaller regional brain volumes than PWoH, with similar age-related volume loss slopes, except in lentiform regions.
- In PHWD, smaller brain volumes and advanced age significantly interacted, predicting greater cognitive decline.
Conclusions:
- Viral suppression in PWH prevents accelerated cognitive decline and brain volume loss compared to PWoH.
- PHWD are at increased risk for accelerated cognitive decline, underscoring the importance of viral load management in aging PWH.
- Achieving viral suppression mitigates accelerated brain aging in PWH.
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