The Role of Nutrition in HIV-Associated Neurocognitive Disorders: Mechanisms, Risks, and Interventions

Abstract

HIV-associated neurocognitive disorders (HANDs) refer to a range of cognitive deficits that afflict people living with the Human Immunodeficiency Virus (HIV). The fundamental processes of HAND include persistent inflammation, immunological activation, and direct viral impact on the central nervous system. Emerging research shows that nutritional status, especially food consumption and body weight, is critical in determining the course and severity of HAND. Malnutrition exacerbates neurocognitive impairment by increasing inflammation and oxidative stress, while obesity may contribute to HAND through the promotion of metabolic disruption, gut microbiota alterations, and systemic inflammation. Additionally, the introduction of antiretroviral treatment (ART) has substantially enhanced the prognosis of people living with HIV by lowering viral load and improving immune function. However, depending on the regimen, ART can cause changes in body weight, which may influence the progression of HAND. This emphasizes the intricate interplay between HIV, nutrition, body weight, and neurocognitive health. As a result, various dietary approaches are currently being investigated to improve the quality of life of individuals with HIV and possibly help prevent neurocognitive decline in this population. This review aims to elucidate the relationship between nutrition and neurocognitive function in individuals living with HIV, shedding light on aspects of HANDs related to diet, body weight fluctuations, and metabolic syndrome. It explores the shift from current pharmacological treatments to innovative non-pharmacological interventions, including specific dietary strategies, to support overall health and cognitive well being in HIV-positive people.

Keywords: HIV-associated neurocognitive disorders (HANDs); acquired immunodeficiency syndrome (AIDS); anti-retroviral therapy (ART); body weight; food; human immunodeficiency virus (HIV); inflammation.

Figure 1

Flow chart describing the assessment of neurocognitive disorders in people living with HIV. The flowchart illustrates the assessment and clinical management of HIV-associated neurocognitive disorders (HANDs) in people living with HIV. The chart outlines the diagnostic assessment, including screening, neuropsychological evaluation, and classification of HAND subtypes, followed by clinical interventions aimed to ameliorate life expectancy and the quality of life of HIV-positive people.

Figure 2

Cognitive impairments in people with HIV. This figure summarizes the mechanisms that occur in people with HIV and neurocognitive disorders. The virus itself can cause neuroinflammation, which is followed by the release of pro-inflammatory markers and microglial activation; the release of oxygen reactive species, leading to synaptic loss; and cognitive impairments.

Figure 3

HIV-associated neurocognitive disorders (HANDs), risk factors, and dietary interventions. HAND is classified into three subgroups based on severity: asymptomatic neurocognitive impairment (ANI), HIV-associated mild neurocognitive disorder (MND), and HIV-associated dementia (HAD). These disorders are marked by deficits in learning, motor function, and cognition, including impairments in executive functions, verbal fluency, and working memory. HAND onset involves both the direct effect of HIV infection and viral replication, or it can be attributed to other risk factors that are HIV-related, including long-term antiretroviral therapy (ART), metabolic syndrome (MetS), lack of access to safe and nutritious food (food insecurity), poor dietary patterns, and micronutrient deficiency. Among people living with HIV, children and elderly patients are particularly vulnerable to develop HAND due to developmental and age-related changes that affect the CNS. In addition, prolonged or delayed ART initiation in these subgroups can also increase the risk of HAND. Despite that, they are still underrepresented in HIV research, contributing to inadequate understanding of HAND onset and a lack of optimized treatment interventions. Dietary interventions represent an easy and non-invasive promising adjunctive strategy to improve cognitive outcomes in HIV patients, with commonly used approaches emphasizing high-fat, low-carbohydrate, moderate-protein regimens that are enriched in fruits, vegetables, whole grains, nuts, and olive oil along with a reduction in sodium intake and targeted micronutrient supplementation.