Aging HIV patients face new reality

By Julie Robert

While growing older with HIV is now common, cognitive impairment, a new secondary health issue associated with the disease is being studied by researchers.

Twenty-four years ago, Robert (not his real name) was infected with HIV. With the right combination of treatments, he has been able to live a relatively healthy life. However, a few years ago, Robert started to experience concentration and memory problems. Holding something and not remembering where he wanted to put it, or opening the fridge and not remembering why, became common events for this active 59-year old.

Although many of us may wonder if we are losing our memory as we age, a new study is looking at whether there is a link between deteriorating cognitive abilities in some people with HIV. Robert is one of the participants in this innovative study conducted by the McGill University Health Centre (MUHC) and The Montreal Neurological Institute and Hospital – The Neuro – that is assessing cognitive function in patients living with HIV. He decided to take part to help the cause and advance science. “I don’t know if my problems are related to age, the virus or something else,” he says. “But if I can help, I will.”

The new face of HIV

Thanks to the availability of highly effective antiretroviral therapy (HAART), many people infected with HIV are now able to live into old age. However, it seems that secondary health problems, such as cognitive decline, are surfacing in some people.

“At the beginning of the epidemic, people with HIV had to stay home from work because they were physically sick,” says Dr. Marie-Josée Brouillette, a psychiatrist and researcher at the Research Institute of the MUHC (RI-MUHC) who is spearheading this project with her colleague Dr. Lesley Fellows of The Neuro, adding, “Thirty years later, the problem now is they want to continue their professional lives, but if there are issues with concentration this can lead them to feeling less effective mentally.”

According to Dr. Brouillette, many studies have documented that between 30 and 50 per cent of people living with HIV have mild cognitive impairments such as problems with attention, concentration and memory.

In partnership with Clinique médicale l’Actuel, the study’s multidisciplinary team—composed of psychiatrists, neurologists, neuropsychologists, epidemiologists and HIV physicians—is currently developing a new tool to measure cognitive abilities in HIV patients.

The goal is to develop a battery of computer-based tests that are free and remotely accessible and that can reliably measure cognitive ability in just a few minutes. “Our statistical analysis method (called a Rasch analysis) is a clinical epidemiology model which, in this case, represents an innovative approach,” says Dr. Brouillette. “We are shedding new light on the relationship between cognitive symptom complaints and test results.”

The research project involves approximately 100 patients who go to either Clinique médicale l’Actuel or the MUHC to take a series of online tests, which they take again three months and six months later.

Finding avenues for treatment

In spite of good viral control and blood tests, some patients have the HIV virus in their brains, which may result in cognitive losses. Currently, the only test that can screen for HIV in the brain is a lumbar puncture—a procedure that is invasive and not appropriate in all cases. “An outcome of this study is that we may be able to measure if cognitive decline is related to a presence of the virus in the brain,” says Dr. Brouillette. “The challenge for researchers is to develop a series of reliable tests that are easy to administer to larger cohorts of study participants. This will allow scientists to expand their knowledge in this emerging field and potentially identify interventions that could mitigate the negative impact of the virus on patients’ cognitive ability.”