Chapter 33 : Interaction of the Aging Process with Neurobehavioral and Neuro-AIDS Conditions in the HAART Era

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The foregoing introduction to the epidemiology of aging in HIV-1 infection leads us to an important preliminary conclusion. That is, the study of older age in HIV-1 infection is more properly considered as (i) the study of a population of newly infected older individuals and (ii) the study of a separate group of long-term HIV-1-infected patients successfully treated with highly active antiretroviral (ARV) therapy (HAART). The authors used a generalized linear models approach with age category, HIV-1 disease category (HIV-1 seronegative, CDC stage B/early symptomatic HIV-1 infection, and CDC stage C/AIDS), and their interaction as predictors of the total number of MCMD symptoms (zero to six) defined by the American Academy of Neurology. Given the hypercortisolemia-induced neuronal cellular toxicity associated with major depressive disorder and with chronic stressor exposure, both of these conditions may enhance the likelihood of neurocognitive impairment (NCI) and neurocognitive disorder when superimposed upon the toxicities associated with the aging process and HIV-1 infection of the brain. In addition to the consideration of how aging might interact with HIV-1 infection in specific neuro-AIDS conditions, an overarching issue exists. That issue is related to how an increased frequency of medical comorbidities might interact with aging in the likelihood of expression of neuro-AIDS conditions.

Citation: Goodkin K, Concha M, Jamieson B, Molina R, Lopez E, Zheng W, Asthana D, Hardy W. 2009. Interaction of the Aging Process with Neurobehavioral and Neuro-AIDS Conditions in the HAART Era, p 473-486. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch33
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The overlap of two populations, older persons and the HIV-1 infected, has been increasing in recent years. A third population, those with NCI, normally significantly overlaps each of these populations independently. In the intersection of those with older age and those with HIV infection, the area of such overlap is expected to be proportionately greater. In association with this overlap, it is expected that there will be a high rate of decrements of functional status in the activities of daily living that are most closely related to NCI. In turn, it is expected that there will be proportionately higher rates of the HIV-1-associated neurocognitive disorders (MCMD and HAD). These disorders relate particularly well to anticipated immunological changes occurring in this overlap group—decreases in naive CD4 cell counts and increases in the activation state of CD8 cells, as well as in the secretion of proinflammatory cytokines (TNF-α, IL-1, and IL-6). These immunological changes are expected to be associated with virologic changes characterized by an increase in the elaboration of neurotoxic viral proteins (gp120 and Tat).

Citation: Goodkin K, Concha M, Jamieson B, Molina R, Lopez E, Zheng W, Asthana D, Hardy W. 2009. Interaction of the Aging Process with Neurobehavioral and Neuro-AIDS Conditions in the HAART Era, p 473-486. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch33
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