Dementia Risk Linked to Delayed HIV Treatment, But Incidence Declining
Waiting to begin antiretroviral therapy (ART) for HIV may increase the risk of dementia later in life, according to recent research from Kaiser Permanente. Still, a new study indicates that dementia diagnoses are declining in people with HIV, approaching rates seen in the general population.
The Link Between Delayed ART and Dementia
Research published in PubMed demonstrates a correlation between delayed initiation of ART and an increased risk of dementia. Specifically, patients who started ART with a low CD4 count – indicating a more advanced stage of HIV infection – were more likely to receive a dementia diagnosis years later. A Kaiser Permanente analysis underscores the importance of early HIV identification and treatment to mitigate this risk.
Recent Trends Show Declining Dementia Incidence
Despite the increased risk associated with delayed treatment, overall dementia diagnoses are decreasing in both people with and without HIV. A Kaiser Permanente study analyzing data from 2000 to 2023, involving over 24,762 individuals with HIV and nearly 495,000 without, found that incident dementia diagnoses declined in both groups. The decline was more pronounced in people with HIV (-7.68% per period) compared to those without (-2.70% per period).
While the incidence of dementia was initially higher in people with HIV (an adjusted incidence rate ratio of 1.72), this difference became less significant in the most recent period studied (2020-2023), with an adjusted rate ratio of 1.16. This improvement is likely due to earlier ART initiation and better overall HIV management.
Prevalence Remains Elevated
Although the incidence of new dementia diagnoses is decreasing, the prevalence of dementia remains higher in people with HIV. The study found an adjusted prevalence ratio of 1.71, and 1.59 in the 2020-2023 period. This suggests that individuals with HIV may carry a lasting risk of dementia, potentially stemming from earlier years of infection before widespread ART availability.
Importance of Cognitive Health in HIV Care
Researchers emphasize the need for sustained attention to cognitive health and the integration of dementia-related services into HIV care. “The finding that delayed ART can raise the risk of age-related dementia is eye-opening,” said study co-author Craig E. Hou, MD, a neurologist with The Permanente Medical Group, in a Kaiser Permanente press release. “Dementia risk involves multiple factors…and can be even more complex among people with chronic disease.”
Key Takeaways
- Delayed initiation of ART for HIV is associated with a higher risk of dementia.
- Dementia diagnoses are declining in people with HIV, likely due to earlier treatment.
- The prevalence of dementia remains higher in people with HIV, potentially due to past infection stages.
- Ongoing attention to cognitive health is crucial in HIV care.