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HIV treatment does prevent cognitive decline

HIV-positive patients have the same risk of dementia as any other person if they take viral-suppressing medication and live a healthy lifestyle, new research shows.  

One of the most debilitating effects of HIV is the neurocognitive decline, which can range from memory and language issues to dementia. 

Until now, research suggested that even those who take anti-retroviral therapy, the viral suppressing drug, had a higher risk of brain disorders than the general population.

But new research by McGill University in Canada refutes that, and shows that those who successfully suppress their viral load and live healthily have the same lifetime risk of dementia and other brain disorders as any other person. 

This new study on well-treated healthy patients shows that those who do manage to suppress their viral load have the same cognitive function and dementia risk as any other person

Lead author Dr Ryan Sanford, in the university’s biomedical engineering department, said the difference here is that his team studied 55 ‘pristine’ patients, while previous studies analyzed older patients with advanced disease, who did not have today’s advanced drugs.

It means those older patients’ brains may already have been ravaged by the disease, and medication couldn’t reverse the damage, which would typically trigger symptoms within three or four years.

This new study, Sanford says, offers a much more realistic perspective for today’s patients, who have access to such effective drugs that they can reach an undetectable viral load within months, and stay that way for life. 

For the study, Sanford and colleagues examined 48 adults with HIV treated with cART with good viral suppression as well as 31 adults who did not have HIV for comparison. 

Both groups were about half women, with an average age of around 48 for the HIV-positive adults and 51 for the HIV-negative adults.

Over the course of two years, the researchers assessed their brain changes using MRI scans.

In particular, they focused on the cortical thickness and subcortical volumes. They also assessed their cognitive performance using neuropsychological assessments.

At first, those with HIV had poorer cognition and reduced brain thickness and volume than adults without HIV.

However, by the end of the study, there were barely any differences between the two groups.  

‘We are working with people who are very well-treated,’ Sanford told Daily Mail Online. 

‘This is the goal of the future: well-treated patients with an undetectable viral load living normal healthy lives, ageing as  normal.

‘The subjects we had were pristine, living healthily and taking their medication.’ 

He says that although the findings come from a small study, they may help de-stigmatize HIV testing, and encourage people to start treatment as early as possible.

‘It’s a hopeful message. There’s a lot of literature out there that says “yeah, you can be treated but when it comes to the brain we’re not sure”. This shows something different.’