Photo Credit: Zinkevych

Simulation modeling projects more than 22% of men and 16% of women with HIV who are currently 60 would develop age-associated dementia by 80 years of age.

“It is a vital time to be studying aging among people living with HIV,” Emily P. Hyle, MD, MSc, notes. “People with HIV who are virologically suppressed on ART will live normal or near normal life expectancies, and it’s essential to better understand how to manage and improve the aging process. Currently, almost half a million people living with HIV in the United States are aged older than 50.”

For a study published in AIDS, Dr. Hyle and colleagues used simulation modeling to project the cumulative incidence and mortality associated with age-associated dementias among patients with HIV aged 60 and older compared with the general population. The researchers estimated age-associated dementia incidence and age-associated dementia-associated mortality. Projected outcomes included age-associated dementia cumulative incidence, life expectancy, and quality-adjusted life-years. They also performed sensitivity and scenario analyses on age-associated dementia-specific (eg, incidence) and HIV-specific (eg, disengagement from HIV care) parameters, as well as premature aging among patients with HIV.

Physician’s Weekly (PW) spoke with Dr. Hyle to learn more about the study results.

PW: Why study projections related to age-associated dementia in HIV?

Dr. Hyle: Simulation modeling offers an opportunity to use what we know now about aging and project into the future to see what might unfold for people living with HIV as they age over the next 10-20 years. As we gain a more nuanced understanding of this aging process, we can better address prevention, screening, and treatment approaches to improve the health and lifespan for people with HIV on ART.

What factors related to HIV or ART could influence age-associated dementia?

This is an important question. We are learning more about this every year. There are concerns that chronic inflammation associated with HIV infection could contribute to accelerated incidence and progression of age-associated dementia in people living with HIV. Tobacco use and depression are common among people with HIV in the US, which can contribute to cardiovascular disease and vascular causes of dementia. Structural barriers to care and discrimination also contribute to differences in the diagnosis, progression, and treatment of age-associated dementia for people living with HIV in the US.

What did you and your colleagues set out to determine?

We sought to project the future cumulative incidence, QOL, and mortality associated with age-associated dementias among people aging with HIV in the United States. These types of projected estimates are useful to highlight future challenges by showing that there are likely to be many people living with HIV who could develop dementia over the next decade and will need improved strategies for screening, treatment, and support.

Can you provide a brief overview of the results?

Using simulation modeling, we projected that more than 22% of men and 16% of women with HIV who are currently 60 would develop age-associated dementia by the time they reach 80. These model-projected estimates are higher than what is reported in the general population and reflect both higher incidence of dementia among people with HIV, as well as higher rates of other causes of death such as cancers and heart disease.

What are the implications of your findings?

These model-based findings underscore that clinicians need to talk with their patients with HIV about opportunities to reduce the risk for dementia, including smoking cessation, cardiovascular risk factor reduction, hearing loss screening and treatment, and screening and treatment for depression, among others. As we learn more about approaches to reduce the risk for dementia and slow the progression of dementia among the general population, and in people with HIV specifically, it will be important to incorporate these recommendations in the clinical setting. Shared decision-making with patients is important for clinicians to support patients in prioritizing their QOL as they age.

What would you like to see future research focus on?

Future research is essential to better understand the aging process for people living with HIV. Understanding the development of cognitive decline, modifiable risk factors for progression to dementia, and better screening and treatment approaches are all major needs to improve the health and lifespan of people living with HIV.