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. 2019 Apr;10(2):227-238.
doi: 10.1007/s41999-019-00164-6. Epub 2019 Jan 21.

How all-type dementia risk factors and modifiable risk interventions may be relevant to the first-generation aging with HIV infection?

Htein Linn Aung  1   2   3 , Scherazad Kootar  2 , Thomas M Gates  1   2 , Bruce J Brew  1   3 , Lucette A Cysique  4   5   6
Affiliations

How all-type dementia risk factors and modifiable risk interventions may be relevant to the first-generation aging with HIV infection?

Htein Linn Aung et al. Eur Geriatr Med. 2019 Apr.

Abstract

Purpose: The purpose of this review is to provide an overview of established risk factors for all-type dementia and results of interventions on dementia modifiable risk factors, all with relevance to aging people living with HIV (PLHIV).

Methods: Narrative literature review.

Results: Our review identifies a high prevalence of risk factors for dementia in the global HIV population that is entering dementia age range (60 +), in relation to both traditional and HIV-specific risk factors. This includes age (HIV-related premature aging and possibly HIV-related accelerated brain aging and cerebrovascular injury), HIV-related and non-HIV-related cardiovascular diseases burden with related-vascular brain damage, HIV-associated neurocognitive disorders, high mental health burden, low educational/socio-economic status, historical immune compromise, and persistent immune activation with consequent augmented immune senescence. Our review highlights that the results of interventions on all-type dementia modifiable factors show discrepancies between positive observational study results and inconclusive clinical trials. The main reasons for such discrepancies relate to the preventative framework that complex interventions' trials have difficulty to emulate and the suboptimal measurement of cognitive change. Multi-domain intervention trials are now advocated to concomitantly tackle complex age-related comorbid profiles.

Conclusions: The burden of dementia risk in aging PLHIV is higher than that in the general population, particularly in the most vulnerable clusters. Epidemiological studies are urgently needed to provide accurate estimates. Lessons from interventions trials in all-type dementia on modifiable factors need to be carefully considered for enhancing trials' potential in aging PLHIV. A comprehensive and preventative neurogeriatric healthcare response linked with HIV communities and dementia associations should be urgently put in place.

Keywords: Aging; Dementia; Dementia modifiable risk factors; HIV-associated neurocognitive disorders; HIV/AIDS; Interventions; Risk factors.

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