Next steps for improving neurocognition among older people with HIV

A new position paper crafted by an international group of experts calls for increased prevention, early detection, and treatment of neurocognitive concerns related to aging with HIV. The alliance of clinical and community leaders also proposes a multinational hub that includes guidelines for managing such conditions in a variety of settings, including low- and middle-resource areas.

About This Study

“Fostering healthy cognitive ageing in people living with HIV” was published online on Nov. 27, 2024, in The Lancet HIV. The lead authors are Lucette A. Cysique, Ph.D., and Sean B. Rourke, Ph.D., both of the MAP Centre for Urban Health Solutions at the Li Ka Shing Knowledge Institute of St Michael’s Hospital in Toronto, Ontario, Canada, and other institutions.

Key Points

This position paper from the multinational NeuroHIV and Aging Advocacy Group outlines a strategy for preventing, diagnosing, and treating neurocognitive issues in older people living with HIV. Risk factors for brain issues include structural questions such as socioeconomic conditions, modifiable factors such as cardiometabolic problems, and fixed parameters such as genetic health.

Neurocognitive decline is a gradual process that needs to be assessed early so potential issues, such as poor cardiovascular health, can be addressed before symptoms appear. Public awareness of signs of mild impairment in people living with HIV–especially among their caregivers–can help people get screened sooner.

Such assessments could be performed in HIV clinics, with best practices including culturally and linguistically appropriate tools. There are pros and cons to informing patients about screening results, including the impact of a neurocognitive diagnosis on a patient’s mental health. Training HIV providers in geriatric care, including cognitive health, could improve management of such issues in older people living with HIV.

Addressing neurocognition in the context of HIV has been studied mainly in resource-rich areas of the world. This paper lists challenges for adapting study results to low- and middle-resourced countries, including cultural and socioeconomic issues, late HIV diagnosis and treatment start, and limited government resources. Non-pharmaceutical interventions could be helpful in this context.

Issues to Be Resolved

The authors issued a call to action that includes health care challenges, such as adapting general population resources to people living with HIV, research needs (diagnostic criteria, appropriate tools, and clinical drug trials in people living with HIV), and the establishment of a knowledge hub that includes current research and the experiences of older people living with HIV and neurocognitive issues. Once that information has been compiled, guidelines for managing HIV-associated neurocognitive disorder in different settings can be developed.

By Barbara Jungwirth