HIV-Related Dementia Worsens in Patients with Depression and Peripheral Inflammation

 

by John Otrompke

Dementia which occurs in people with HIV can be distinguished from Alzheimer’s disease and warrants different treatment, according to a poster presented at this year’s annual meeting of the American Neurological Association, which took place virtually.

Markers for inflammation found in HIV patients are associated with cognitive decline, whereas amyloid markers were not, according to poster 368, “Peripheral Inflammation and Depressed Mood Independently Predict Neurocognitive Worsening Over.”

“HIV dementia is different from Alzheimer’s because it is one of the few treatable dementias. When patients go on anti-retroviral therapy and achieve suppression, they also get cognitive improvement,” explained Ronald Ellis, MD, PhD, professor at the University of California-San Diego, lead author on the poster.

The researchers measured cognitive decline over 12 years in 191 patients with HIV. Inflammation biomarkers such as interleukin-6, C-reactive protein, and soluble tumor necrosis factor type II were associated with greater neuro-cognitive decline (p=0.02), as was depressed mood at entry (p=0.0004). On the other hand, biomarkers like amyloid beta 42 and solid amyloid precursor proteins (sometimes thought to be associated with Alzheimer’s disease) were not associated with greater cognitive decline in HIV patients.

There are other differences as well, according to Ellis. “Although classic Alzheimer’s proceeds at a more rapid rate, people with HIV develop cognitive problems earlier.”

And while viral suppression is associated with cognitive improvement, it doesn’t restore cognition to normal, he explained. However, researchers have speculated that treatment intensification could actually reverse the decline, he added.

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