Persons over age 50 are not only aging with human immunodeficiency virus (HIV) infection but also represent a high proportion of new HIV infections. Neuropsychiatric symptoms, including depression, cognitive impairment, and substance abuse, are very common in individuals infected with HIV. However, there is little understanding of the relationship between these HIV-related comorbid conditions in newly infected elderly patients compared to uninfected elderly and those who have survived after 20 years of HIV/AIDS. We summarize the current theories and research that link aging and HIV with psychiatric illnesses and identify emerging areas for improved research, treatment, and patient care.
"Healthy individuals >65 are designated elderly by the Centers for Disease Control, but HIV infected individuals are designated “aged” HIV patients at >50, due to progressed signs of aging. It is predicted that by 2015, over 50 % of AIDS cases in the USA, and 15 % of newly diagnosed cases will be >50 (Erlandson et al. 2012; Watkins and Treisman 2012). Reports have demonstrated that aged HIV patients have increased risk of severe depression and cognitive impairment, less time between infection and AIDS diagnosis and reduced T-lymphocyte proliferation (Watkins and Treisman 2012). "
[Show abstract][Hide abstract] ABSTRACT: Aged (>50 years old) human immunodeficiency virus (HIV) patients are the fastest-growing segment of the HIV-infected population in the USA and despite antiretroviral therapy, HIV-associated neurocognitive disorder (HAND) prevalence has increased or remained the same among this group. Autophagy is an intracellular clearance pathway for aggregated proteins and aged organelles; dysregulation of autophagy is implicated in the pathogenesis of Parkinson's disease, Alzheimer's disease, and HAND. Here, we hypothesized that dysregulated autophagy may contribute to aging-related neuropathology in HIV-infected individuals. To explore this possibility, we surveyed autophagy marker levels in postmortem brain samples from a cohort of well-characterized <50 years old (young) and >50 years old (aged) HIV+ and HIV encephalitis (HIVE) patients. Detailed clinical and neuropathological data showed the young and aged HIVE patients had higher viral load, increased neuroinflammation and elevated neurodegeneration; however, aged HIVE postmortem brain tissues showed the most severe neurodegenerative pathology. Interestingly, young HIVE patients displayed an increase in beclin-1, cathepsin-D and light chain (LC)3, but these autophagy markers were reduced in aged HIVE cases compared to age-matched HIV+ donors. Similar alterations in autophagy markers were observed in aged gp120 transgenic (tg) mice; beclin-1 and LC3 were decreased in aged gp120 tg mice while mTor levels were increased. Lentivirus-mediated beclin-1 gene transfer, that is known to activate autophagy pathways, increased beclin-1, LC3, and microtubule-associated protein 2 expression while reducing glial fibrillary acidic protein and Iba1 expression in aged gp120 tg mice. These data indicate differential alterations in the autophagy pathway in young versus aged HIVE patients and that autophagy reactivation may ameliorate the neurodegenerative phenotype in these patients.
Journal of NeuroVirology 01/2013; 19(1). DOI:10.1007/s13365-012-0145-7 · 2.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The diagnosis of human immunodeficiency virus (HIV)-associated neurocognitive impairment is time-intensive and often omitted in busy outpatient settings. Brief screening tools are needed. The Montreal Cognitive Assessment (MoCA) and the Alzheimer's disease (AD)-8 have been used in neurodegenerative disorders. We evaluated the sensitivity and specificity of these brief screening tools in HIV-infected persons. The AD-8, MoCA, and formal neuropsychological testing were administered to 200 HIV-infected patients who were followed at a single institution. Normalized scores on formal neuropsychological testing were used to define neurocognitive impairment. The sensitivity and specificity of the MoCA and AD-8 were assessed to diagnose the impairment. Neurocognitive impairment was highly prevalent in this cohort: 127 persons (64 %) were diagnosed with neurocognitive impairment based on formal testing. Using the AD-8 and MoCA, 113 (57 %) and 101 (51 %) persons were identified with neurocognitive impairment, respectively. The sensitivity and specificity of MoCA were 63 % and 71 %, respectively. The sensitivity and specificity of AD-8 were 61 % and 51 %, respectively. Our findings highlight that brief screening tools correlate with formal neuropsychological testing. However, the sensitivities of these screening tools are lower than desired. Nevertheless, given their ease in administration, these tools could assist as a first line for identifying individuals who may subsequently require formal neuropsychological testing.
Journal of NeuroVirology 01/2013; 19(1). DOI:10.1007/s13365-012-0147-5 · 2.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose of review:
The effect of HIV and aging on brain functions is an increasingly important topic of research: HIV-infected (HIV+) persons aged ≥50 represent a growing part of the HIV epidemic. Research is embracing this new axis, but there has been a lack of conceptualization of the factors that are at stake in both aging and HIV. To start to remedy this theoretical limitation, we are proposing a research framework in the hope that it will optimize how research questions and findings are formulated. Moreover, in the light of this proposed research framework, we review the last 3 years' research findings.
Our review highlights that as HIV+ persons are aging, there is some signal for acceleration of normal aging processes and facilitated expression of age-associated diseases. Evidence for dramatic neurodegeneration in aging HIV+ persons remains limited and may be different in nature to typical neurodegenerative processes. Also, it should be kept in mind that most HIV+ persons are still below age 60. The vast majority of studies are still cross-sectional thereby underlining the critical importance of longitudinal studies to fully assess the effect of comorbidities.
The complex effects of aging and nonaging comorbidities and key HIV effects (as opposed to only HIV status) need to be taken into account in future research by increasing sample size and selecting the most appropriate control group(s). Ideally, life-span studies should be established using neuropsychological and neuroimaging outcomes that have a proven track record in both HIV-related brain injury and brain aging. These would be similar to those that exist in non-HIV aging research and would optimally account for comorbidity effects and survivor bias.
Current Opinion in HIV and AIDS 05/2014; 9(4). DOI:10.1097/COH.0000000000000078 · 4.68 Impact Factor
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