This well-planned study linked a diverse group of factors to cognitive impairment or decreased cognitive performance (falling mental performance) in middle-aged and older men with HIV infection responding very well to antiretroviral therapy. The factors tied to worse cognitive performance included one HIV-related factor (lower lowest-ever CD4 count), one behavioral factor (smoking marijuana), one body size factor (above normal waist-to-hip ratio), and four non-HIV diseases or conditions (cardiovascular disease, diabetes, poor kidney function, and symptoms of depression).
Thus the study strongly suggests that different processes may contribute to cognitive impairment or decreasing cognitive performance in men with HIV. Some of these processes may be directly related to HIV infection (lowest-ever CD4 count) and some may be indirectly related or unrelated to HIV. In this way the study confirms that as people grow older with HIV infection (most men in this study were in their late 40s through early 60s), many aspects of their health and behavior are closely related to each other. For example, a person with diabetes runs a higher risk of poor kidney function and cardiovascular disease -- three of the cognitive impairment risk factors in this study.
The researchers point out that all the factors they linked to cognitive impairment or performance in this study have been linked to cognitive problems in the general population and/or in people with HIV in previous studies. Most of these risk factors can be avoided, controlled, or reversed. Following your HIV provider's advice to lead a healthy lifestyle can go a long way toward preventing or controlling cardiovascular disease, diabetes, kidney disease, and overweight or obesity (indicated here by a high waist-to-hip ratio). Elements of a healthy lifestyle that may affect all these conditions are quitting (or not starting) smoking, maintaining a steady level of physical activity, eating a balanced diet, and avoiding excessive alcohol or party drug use.
Depression affects many people with HIV. But providers often fail to notice or treat depression in people with HIV.5 If you think you have depression (feelings of persistent sadness or hopelessness), talk to your provider about it. Several medications, with or without short-course psychotherapy, can help people overcome depression.
Previous studies have linked smoking marijuana to cognitive problems in people with and without HIV. Some people smoke marijuana for health reasons (for example, to control neuropathy [foot pain], nausea, or mood problems), and some people smoke pot just because they like it. In either case, marijuana smokers should realize that too much pot can negatively affect cognitive performance and have other bad effects on their health. Medical marijuana is legal in many parts of the United States and Western Europe. If you think marijuana can help relieve physical problems you have, you should get advice from a health professional on using it -- you should not try to treat yourself.
The researchers note that results of their study may not apply to everyone with HIV. All HIV-positive participants in this study were 45-year-old or older men in whom antiretroviral therapy had kept the viral load undetectable for many years. And 93% of HIV-positive study participants were gays or other men who have sex with men. The researchers also stress that this kind of study does not prove the identified factors cause cognitive problems -- only that these seven factors are somehow linked to cognitive problems.
* A normal waist-to-hip ratio is below 0.9, meaning waist width should be less than 90% of hip width.
** As judged by increased albumin-to-creatinine ratio.
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