Many people living with HIV (PLWH) are concerned by reports that mild cognitive impairment is more common, and occurs at a younger age, in people living with HIV than in other people. A new study from Holland gives us a clearer picture of this problem.

Mild cognitive impairment can become evident in the form of changes such as reduced attention span, slower information processing, reduced fluency in the use of language, and a reduced ability to plan and organise everyday life or to solve problems. These changes are greater than the declines in memory and mental sharpness that are typical as people get older.

Regardless of HIV, there are a wide range of causes of cognitive impairment, including cardiovascular disease, drug use, medication side-effects, vitamin and thyroid deficiency, and depression or anxiety. Many of these are treatable.

The researchers compared HIV-positive men over the age of 45 doing well on HIV treatment with those of a very similar group of HIV-negative men. Some previous studies have probably over-estimated the number of people with cognitive impairment. The researchers here refined their techniques to estimate this and used a battery of tests to assess neurocognitive function.

They did find a clear difference in the rates of cognitive impairment. Their results showed that 17% of the HIV-positive men and 5% of the HIV-negative men had mild impairment. They looked further to identify the factors associated with cognitive impairment in the HIV-positive group. They were:

  • Cannabis use
  • Cardiovascular disease: build-up of plaque in the arteries, chest pain due to heart problems, heart attack etc.
  • Kidney problems
  • Type 2 diabetes
  • Having excess fat around the belly (a high waist-to-hip ratio)
  • Symptoms of depression
  • Having previously had a very low CD4 count.

The most important of these factors are at the top of the list. The researchers emphasise that it is a combination of factors which appears to raise the risk of cognitive impairment. They say that it is biologically plausible that heart and kidney problems contribute to cognitive impairment – and that these issues are increasingly common as people with HIV get older. Having experienced severe immune deficiency in the past (a low CD4 count) also contributes.

The full article can be read here.