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When I'm 64: Neurodegeneration, Epigenetic Aging, and Cognition in Older People With HIV - Alan Winston
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CROI 2026 Symposium
Alan Winston purports in his talk that HIV itself does not cause cognitive decline more than seen in HIV-neg. in aging PWH, except when there is a legacy affect (late ART, low CD4), or when these conditions listed below are present, stigma, comorbidities, social determinants of health, but not HIV. He does say legacy HIV effect, low nadir CD4, late ART start can contribute to cognitive impairment, and ongoing viremia too can cause CI, so can depression/mental health issues.
I do not agree. Many HIV neurologists agree with me and have reported research to support that HIV can contribute to cognitive decline for older aging PWH, more than HIV-neg. It is difficult to study & prove due to confounders. The COBRA & POPPY studies do not capture broad populations, the study populations are young & homogenous, Cognitive impairment generally starts to rear its head in older ages. In POPPY average was 57 in older PWH, 85% men. 86% white, all participants acquired HIV through sexual contact. Their 2016 paper concluded: "HIV-positive individuals exhibit poorer cognitive function when compared to an appropriate HIV-negative control group. Although the difference in the overall cognitive score is statistically significant, this would not be considered clinically meaningful". Researchers general have not studies this area vey well & it is difficult to study for many reasons including the confounders, so this issue of HIV itself causing CI remains controversial. Several research papers have found HIV itself contributes to cognitive impairment (CI) such as by Zaunders, Brew & Zuzuki from Australia, that HI -RNA transcripts in CSF are linked to brain injury, presented at CROI 2022.
Here is Alan Winston’s presentation at CROI:
Download the PDF here
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