Cognitive impairment persists in people with HIV despite effective antiretroviral therapy, and evidence for additional interventions to prevent cognitive decline remains limited. This systematic review commissioned by WHO examined pharmacological and non-pharmacological approaches and found insufficient data to establish clear effectiveness, highlighting a significant gap in treatment protocols for HIV-related cognitive decline.
Key Points
- Cognitive decline occurs in treated HIV despite viral suppression
- Limited evidence supports pharmacological or behavioral interventions
- WHO-commissioned review identifies major treatment protocol gap
Longevity Analysis
HIV-related cognitive decline represents a distinct longevity challenge: viral suppression alone does not resolve the underlying neuroinflammatory and metabolic dysfunction that compromises cognitive function. The absence of validated interventions points to a critical need to understand how persistent viral protein exposure, chronic immune activation, and altered energy metabolism in neural tissue continue to drive decline even when viral replication is controlled. This finding underscores that managing HIV for longevity requires moving beyond single-target approaches—addressing the inflammatory milieu, mitochondrial function, and neural regeneration alongside pharmacological control.
Original published by The Lancet Healthy Longevity, by Roopal Desai, Jaime Vera, Tristan Barber, Kate Alford, Clea Tanner, Kavita Kothari, Melissa Melville, Shyn Wei Phua, Elizabeth Fordham, Erin Grace Gardner, Lexi He, Aimee Spector.