Aging with HIV and HIV-associated neurocognitive impairment

Antiretroviral therapy (ART) is the most effective therapeutic intervention for HIV infection. With improved survival, comorbidities, including neuropsychiatric and HIV-associated neurocognitive impairment (NCI) are of increasing concern to aging people with HIV (PWH). The clinical features and the inter-individual variability of the aging process confound the elucidation of the diagnosis and underlying mechanisms of cognitive dysfunction in aging PWH. Herein, we review the clinical aspects of HIV-associated NCI in the aging PWH contrasting to the normative neuro-aging seen in people without HIV (PWoH) and address the growing role of biomarkers to predict the onset of age-related diseases in PWH and their clinical significance. There is an urgent need for further research into the role of specific immune brain biomarkers in predicting the aging process and how these biomarkers may assist in understanding the mechanisms and possible prognosis of age-related neurocognitive comorbidities in aging PWH as an endpoint for interventional studies.