No accelerated aging-related brain atrophy in treated HIV infection

A multicenter longitudinal study with multimodality neuro
imagining and neuropsychological assessments was performed
in 122 virologically suppressed HIV-positive individuals and
78 HIV-negative controls. Controls were matched for age, sex,
years of education, smoking and alcohol use. Median age was
56 years. The median time since HIV diagnosis was 15 years
and the median time on antiretroviral therapy was 13 years. At
baseline gray matter volume was lower, global cognitive performance
was lower, white matter hyperintensity load was higher
and brain-predicted age difference was higher in the HIV-positive
participants compared to the control group. After a median
of 1.97 years the examinations were repeated. There were no
longitudinal differences in rates of change in any neuroimaging
measure between the two groups. Cognitive performance was
stable in both groups. The authors conclude that HIV-positive
individuals who are successfully treated show no signs of accelerated
aging-related brain changes or cognitive decline over 2
years of follow up.

Ref; Cole et al. Clin Infect Dis 2018;66:1899-1909

Comment: Obviously different studies come to different conclusions
regarding accelerated brain atrophy in HIV-infection.
In the present study a proper control group was included and
no evidence of accelerated brain atrophy was found in this
virologically suppressed cohort compared to the HIV-negative
control group. The differences at baseline may be explained
by long periods of untreated HIV infection. The median time
from HIV-diagnosis to initiation of antiretroviral therapy was 2
years and the time from HIV infection to diagnosis is unknown.