Cognitive Impairment Among Older Individuals with HIV Infection

The introduction of combination antiretroviral therapy (CART) has led to a dramatic increase in the survival of HIV seropositive (HIV+) individuals and an aging HIV+ population with over 50 % of HIV+ persons in the USA now over the age of 50. Cognitive impairment is common across the lifespan in HIV but is twice as common among older HIV+ adults. HIV itself may lead to HIV-associated neurocognitive disorders, but cardiovascular risk factors may also contribute to cognitive impairment in older HIV+ adults. Abnormal amyloid deposition in brains of HIV+ individuals at autopsy may also indicate a role of accelerated aging and early-onset Alzheimer disease. We review the evidence to support these three mechanisms of cognitive impairment in HIV+ individuals. Regardless of etiology, cognitive impairment has significant impact on the everyday functioning and quality of life of older HIV+ adults.