An overview of neurocognitive impairment in older people living with HIV

Ng, Rachel QM; Yip, KF; Teh, YiiEan

doi:10.1177/20101058231160605

Cited by 4 publications

(6 citation statements)

References 71 publications

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“…HIV infection disrupts the intestinal barrier, thereby increasing gut permeability and dysbiosis with microbial translocation. The age-associated chronic medical conditions seen in older PLHIV results in visual and hearing impairment, neurocognitive impairment, and sleep disorder, 15 thereby impacting their function. Furthermore, long-term use of ARTs may also contribute to the development or exacerbation of chronic diseases.…”

Section: Multimorbidity In Older People Living With Hivmentioning

confidence: 99%

“…1. 36,43,44 For example, neurocognitive impairment is common in older PLHIV, 15 which results in treatment non-adherence, leading to a vicious cycle of deterioration requiring additional therapies and further nonadherence. The cumulative burden of comorbidities and their therapies leads to frailty in PLHIV at a younger age.…”

Section: Adverse Outcomesmentioning

confidence: 99%

“…Furthermore, studies have shown that in older patients, mental health issues often coexist with physical medical conditions. 15,30 Likewise, PLHIV are often more affected by poor social determinants of health and mental health issues compared with the general population. 31 For instance, they are confronted with stigma and discrimination, resulting in a high prevalence of social isolation and loneliness.…”

Section: Introductionmentioning

confidence: 99%

“…The non‐communicable comorbidities in older PLHIV include metabolic disorders – hypertension and hyperlipidemia, 9,10 cardiovascular diseases, 11,12 anemia, 10 kidney disease, 13 and age‐related conditions, 14 such as cognitive impairment, 15–18 frailty, 18–20 bone disease, 21 multimorbidity 8,10,22–26 and polypharmacy, 7,10,26–29 but are not limited to those listed. Furthermore, studies have shown that in older patients, mental health issues often coexist with physical medical conditions 15,30 . Likewise, PLHIV are often more affected by poor social determinants of health and mental health issues compared with the general population 31 .…”

Section: Introductionmentioning

confidence: 99%

“…Research indicates that in older PLHIV, the burden of multimorbidity and polypharmacy is more linked to the duration of HIV infection than to advanced age itself. 8 The non-communicable comorbidities in older PLHIV include metabolic disordershypertension and hyperlipidemia, 9,10 cardiovascular diseases, 11,12 anemia, 10 kidney disease, 13 and age-related conditions, 14 such as cognitive impairment, [15][16][17][18] frailty, [18][19][20] bone disease, 21 multimorbidity 8,10,[22][23][24][25][26] and polypharmacy, 7,10,[26][27][28][29] but are not limited to those listed. Furthermore, studies have shown that in older patients, mental health issues often coexist with physical medical conditions.…”

Section: Introductionmentioning

confidence: 99%

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An overview of multimorbidity and polypharmacy in older people living with HIV

Yang,

Teh,

Chua

et al. 2023

Geriatrics Gerontology Int

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The availability of effective antiretroviral therapy (ART) has revolutionized the care of people living with HIV (PLHIV). As a result, PLHIV now have a life expectancy comparable with that of the general population. PLHIV are increasingly confronted with age‐related comorbidities and geriatric syndromes, including frailty and polypharmacy, which occur at a higher prevalence and set in at an earlier age compared with their uninfected counterparts. The underlying pathophysiology for multimorbidity and polypharmacy are multifactorial, multidimensional and complex. Therefore, regular review and optimization of risk factors to maintain physical function, social and psychological health is of utmost importance. With an ever‐growing population of older PLHIV, there is a pressing need to provide holistic care to address these emerging issues. Accelerated aging observed in PLHIV suggests that early involvement of a multidisciplinary team, including geriatricians, and implementation of integrated models of care can potentially improve the care of older PLHIV, who are at increased risk of frailty and complex multimorbidity. This article reviews the current global situation, discusses the challenges involved and suggests approaches to deliver comprehensive care for older PLHIV. Geriatr Gerontol Int 2023; ••: ••–••.

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Section: Multimorbidity In Older People Living With Hivmentioning

confidence: 99%

Section: Adverse Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

An overview of multimorbidity and polypharmacy in older people living with HIV

Yang,

Teh,

Chua

et al. 2023

Geriatrics Gerontology Int

Self Cite

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A Review of the Literature on Hiv and Neuropsychological Functioning in Older Adults: Is More Research Needed?

Tragantzopoulou,

Giannouli

2023

PPC

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The increase in the number of ageing people living with HIV and the documented neurocognitive impairments have highlighted the need to illuminate the existing findings and evaluate the impact that HIV has on older individuals. A review of the evidence for neuropsychological declines in memory, executive functions, attention and language in people aged 60 years or more was conducted. The databases MEDLINE, PsychINFO and Pubmed were searched for eligible studies based on keywords. Eight studies of low to high quality that looked at HIV+ older adults (≥ 60) were identified. The majority of older HIV+ adults experienced severe declines in all the cognitive domains under study. There were mixed results regarding the association among advancing age, functioning decline and HIV. Comparisons between HIV-infected and HIV-uninfected older adults showed that HIV+ subjects demonstrate higher scores of cognitive decline in memory, attention, language and executive functions. Further, comparisons among HIV+ adults, demographically matched individuals with mild cognitive impairment of the Alzheimer's type and healthy controls demonstrated that both disease groups perform worse, but the Alzheimer’s type group reports a greater decline in memory and language. Neuropsychological functioning in HIV+ adults presents great decline but studies on this population are limited. As individuals with HIV are increasingly living longer, studies should pay attention to these individuals and examine predictors of neuropsychological decline in the face of well-controlled interventions and treatments. Keywords: HIV, memory, neuropsychological function, executive functions, older adults

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Circulating plasma-derived extracellular vesicles expressing bone and kidney markers are associated with neurocognitive impairment in people living with HIV

Marques de Menezes,

Bowler,

Shikuma

et al. 2024

Front. Neurol.

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BackgroundAlthough effective antiretroviral therapy (ART) has improved the life expectancy of people with HIV (PWH), the prevalence of milder forms of HIV-associated neurocognitive disorders (HAND) persist, and it is associated with systemic and neuro-inflammatory processes that could impact other organ systems. However, the complex signaling mechanisms between the bone-kidney systems and the brain in HAND remain unknown. Extracellular vesicles (EVs) play a potential role in inter-organ communication and are involved in regulating cell activity in distant tissues. In this study, we examined whether levels of EVs from bone-and kidney-related cells associate with cognitive dysfunction and explored the relationship between kidney-bone EV axis in PLW experiencing cognitive deficits.MethodsEV subtypes were characterized in plasma from 61 PWH with either cognitive impairment (CI, n = 53) or normal cognition (NC, n = 8) based on the American Academy of Neurology criteria for HIV-associated dementia (HAD, n = 11), minor cognitive motor disorder (MCMD, n = 25) or asymptomatic neurocognitive impairment (ANI, n = 17) by spectral flow cytometry. EVs were profiled with markers reflecting bone and kidney cell origin. A support vector machine learning-based model was employed for analyses of EV phenotypes to predict the cognitive dysfunction.ResultsPlasma-EVs expressing osteocalcin, sclerostin, and nephrin were significantly higher in the cognitive impairment group compared to the normal cognition group. EVs bearing kidney cell markers correlated significantly with bone-derived EVs. A machine learning-based model, comprised of osteocalcin+, nephrin+, and CD24+ EVs predicted cognitive impairment in PWH on ART.ConclusionOur study reveals that neurocognitive impairment in PWH is associated with increased levels of plasma EVs enriched with the bone markers osteocalcin and sclerostin and the kidney marker nephrin, suggesting that these EV subtypes may be novel candidate biomarkers for disease-spanning neurocognitive dysfunction. Moreover, the relationship between bone-derived EVs with kidney-derived EVs may suggest their role in mediating inter-organ crosstalk in the pathogenesis of HIV-associated cognitive impairment.

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An overview of neurocognitive impairment in older people living with HIV

Cited by 4 publications

References 71 publications

An overview of multimorbidity and polypharmacy in older people living with HIV

An overview of multimorbidity and polypharmacy in older people living with HIV

A Review of the Literature on Hiv and Neuropsychological Functioning in Older Adults: Is More Research Needed?

Circulating plasma-derived extracellular vesicles expressing bone and kidney markers are associated with neurocognitive impairment in people living with HIV

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