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67/100

✓ Peer-reviewed alzhub usefulness score 67 out of 100. Risk factors

Topic: Risk, prevention and care in population studies

As persons with HIV age, noninfectious comorbidities occur more frequently compared with persons without HIV. It is well described that a longer duration of untreated HIV, lower nadir CD4+ T-lymphocyte count, and previous AIDS-defining illnesses are associated with cognitive impairment in persons with HIV [1]. Recent work suggests that these events may occur as early as the first year of HIV infection. Evidence of compartmentalized HIV replication within the CSF was demonstrated in up to 30% of individuals during PHI [13–15]. Conversely, a recent deep sequencing study revealed that only a limited number of persons with AHI had evidence of compartmentalized HIV in CSF, exclusively among those who acquired multiple transmitted or founder (T/F) viruses [16]. The frequency of CSF viral escape was 1% in RV254 participants who commenced ART during AHI [18], compared with up to 5%–10% in individuals who commenced ART during chronic infection. To date, the cohorts investigating early HIV infection on the CNS have predominantly enrolled young men and therefore results may not generalize to other populations with differing demographic factors and comorbidities, including age, sex, coinfections, infection with multiple T/F viruses, and substance use, each of which may alter the degree of HIV transmigration between blood and CSF. Given that macrophage activation markers are strongly associated with cognitive decline, it would be important to investigate whether these markers normalize in the blood compartment over the longer term (>10 years of follow-up) and whether associations with cognitive impairment persist. This is in contrast with what is seen in people with chronic HIV infection, who are at higher risk of further deterioration in cognitive function [19, 20]. A recent study reported that both HIV infection and methamphetamine use increased fractional anisotropy in diffuse tensor imaging, which reflects disruption of white matter tracts and is associated with poorer cognitive outcome [29]. A postmortem study of brain tissues reported the synergistic effects of HIV and drug use on the increase in global DNA methylation, which is associated with neuropsychiatric disorders [35]. Clinical trials of new drugs to treat drug dependency (eg, naltrexone or bupropion for methamphetamine dependence) have had encouraging results and could be used in these interventions [39]. Several studies have demonstrated a higher risk of CSVD, measured by the burden of white matter hype

Key findings

As persons with HIV age, noninfectious comorbidities occur more frequently compared with persons without HIV.
It is well described that a longer duration of untreated HIV, lower nadir CD4+ T-lymphocyte count, and previous AIDS-defining illnesses are associated with cognitive impairment in persons with HIV [1].
Recent work suggests that these events may occur as early as the first year of HIV infection.
Evidence of compartmentalized HIV replication within the CSF was demonstrated in up to 30% of individuals during PHI [13–15].
Conversely, a recent deep sequencing study revealed that only a limited number of persons with AHI had evidence of compartmentalized HIV in CSF, exclusively among those who acquired multiple transmitted or founder (T/F) viruses [16].

Why it matters

This review discusses cognitive impairment in people with HIV, noting that longer untreated infection and lower CD4 counts are linked to cognitive problems, and that starting treatment early may reduce some of these effects. It does not test any treatment, cure or prevention for Alzheimer's disease specifically, and the authors note that most early-infection studies enrolled young men, so results may not apply to other groups.

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Study details

Study designsystematic review
Participants154
Effect size17.8%; 10.8%; 24.8%
Evidence strengthHigh

How this study scored 67/100

Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question.

Component	Points	Why
Journal tier	7 / 10	Tier 3 — peer-reviewed journal (The Journal of Infectious Diseases)
Journal's citation record	3 / 4	The Journal of Infectious Diseases: journal h-index 370 (OpenAlex, 2026-10-29)
Study design	12 / 12	A systematic review of all the studies on the question
Strength of evidence	5 / 5	Rated “high” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	3 / 5	2023 — within 6 year(s) of the newest study here
Sample size	2 / 4	154 participants
Effect reported	2 / 3	Effect reported as a number, without an interval or test
Studied in people	3 / 3	Studied in people (participant count stated)
Randomised / blinded	0 / 2	A review of other studies — randomisation is not credited here
Times cited	3 / 7	Cited 19 times (OpenAlex, 2026-10-10)
Citations per year	2 / 5	3.8 citations a year over 5 year(s) since 2023
Impact for its field and year	2 / 6	Cited 2.3× the average for papers of its field and year (OpenAlex FWCI)
Cited by studies here	0 / 6	No other study in this library cites it
Still being cited	1 / 4	Cited 12 times in 2024–2026 (2026 still in progress; OpenAlex)
Senior author's track record	3 / 4	Last-listed author Alan Winston: h-index 52 (OpenAlex, whole career)
Institution's track record	2 / 3	University of California, San Francisco: institution h-index 1,915 (OpenAlex)
Multi-centre collaboration	3 / 3	OpenAlex lists 12 institution(s) in 7 countries
Indexed in PubMed	2 / 2	Indexed in PubMed (PMID 36930639)
Free to read	2 / 2	Free to read
Total	67 / 100	—

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Read the original

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

Cite this study APA, Vancouver, BibTeX · download .bib or .ris

Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.

APA 7th

Aung, H. L., Alagaratnam, J., Chan, P., Chow, F. C., Joska, J. A., Falutz, J., et al. (2023). Cognitive Health in Persons With Human Immunodeficiency Virus: The Impact of Early Treatment, Comorbidities, and Aging. The Journal of Infectious Diseases. https://doi.org/10.1093/infdis/jiac388

Vancouver

Aung HL, Alagaratnam J, Chan P, Chow FC, Joska JA, Falutz J, et al. Cognitive Health in Persons With Human Immunodeficiency Virus: The Impact of Early Treatment, Comorbidities, and Aging. The Journal of Infectious Diseases. 2023. doi:10.1093/infdis/jiac388. PMID: 36930639.

BibTeX

@article{aung2023-36930639,
  author  = {Aung, Htein Linn and Alagaratnam, Jasmini and Chan, Phillip and Chow, Felicia C. and Joska, John A. and Falutz, Julian and Letendre, Scott Lee and Lin, Woody and others},
  title   = {{Cognitive Health in Persons With Human Immunodeficiency Virus: The Impact of Early Treatment, Comorbidities, and Aging}},
  journal = {The Journal of Infectious Diseases},
  year    = {2023},
  doi     = {10.1093/infdis/jiac388},
  pmid    = {36930639},
  url     = {https://doi.org/10.1093/infdis/jiac388}
}

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