Researchers also suspect the virus may be linked to cognitive issues.
Since the height of the HIV and AIDS epidemic in the 1980s and 1990s, increasingly sophisticated therapies have been able to make quality of life and health better for people living with HIV.
That being said, new research shows that, even after long-term treatment, some people with HIV have an increased risk for cognitive problems.
It was found that even after a decade of treatment, some people have HIV cells in their cerebrospinal fluid.
These people were found to have a higher risk for cognitive defects, even though the researchers behind this finding are quick to clarify there’s no evidence these cells are actually causing these people’s difficulty with their thinking.
The findings underscore that, despite medical strides in recent years, HIV is still a very serious virus that can lead to other related health issues.
The new study, spearheaded by researchers at the University of Pittsburgh School of Medicine, Yale University, and the University of North Carolina, was published last week in The Journal of Clinical Investigation.
Lead author Dr. John Mellors, chief of the division of infectious diseases at the University of Pittsburgh School of Medicine, told Healthline the main goal of the study was to find exactly where in the body HIV still lurks despite rigorous treatment.
To reach their findings, Mellors and his team looked at the cerebrospinal fluid from 69 people who had all been on HIV therapies for an average of nine years. They found nearly half of these people had HIV cells in this spinal fluid.
About 30 percent of these people hit the criteria used to determine impaired cognition. On the flip side, only 11 percent of those who didn’t have the HIV cells in this area showed signs of cognitive problems.
Mellors and his team didn’t expect to find these HIV-containing cells floating in the fluid around the brain in half of those in the study. He wrote in an email to Healthline that he was equally surprised to see these cells actually associated with “poorer neurocognitive function.”
Dr. Mark Mulligan, an infectious disease specialist at NYU Langone Health, says the study has “significance in pointing to additional research questions that need to be answered” in how we think about both a potential cure for HIV and about the brain health of people who have it.
“It extends our current understanding about HIV in the brain,” Mulligan, who wasn’t affiliated with this study, told Healthline.
The need to better understand all of the complexities tied to HIV is high. About 1.1 million people in the United States are currently living with HIV, and another 1 in every 7 is unaware they have it, according to HIV.gov.
While gay, bisexual, and other men who have sex with men (MSM) have an increased risk, HIV is a condition that affects people from all backgrounds and walks of life.
Some groups who aren’t always discussed at length are transgender people, people of color, and particularly women, who have been found in other research to have specific social and economic roadblocks to staying healthy on various treatments.
A lot has changed since the height of the epidemic. For instance, if people adhere to their treatments, they can maintain an undetectable viral load. This means they’re effectively unable to transmit the virus to any HIV-negative sexual partners, according to the
That being said, there’s still more work to be done. HIV is one that so far has no cure, and the virus persists in the body even with the best treatments, Mulligan explains.
“One known location of persistence is in the brain. And we know that cognitive ability can become impaired, sometimes severely — such as dementia — especially in the absence of antiviral treatment,” Mulligan said. “Even with treatment, there may be subtle changes in cognition.”
He says this is most likely due to a range of factors, including the virus directly damaging brain cells; the more indirect effect of a compromised immune system; inflammation damaging brain cells; and other co-existing factors, like co-infections afflicting the brain as well as other comorbidities.
“HIV cognition problems remain significant, but certainly less frequent and less severe in the current era of treatment. However, there is plenty of room for further improvement of brain health in chronically infected patients,” Mulligan said.
“And for research on [a] cure, which would be complete removal of HIV from the body, this work shows that the brain is one place the virus hides in patients on long-term HIV treatment without detectable virus in plasma,” he added.
Mellors says a big takeaway from his research is that people need to understand that HIV could be causing brain dysfunction despite the best treatments, but it remains unknown exactly how HIV in this spinal fluid could exactly be doing this. No direct cause and effect has been established, so he says more work needs to be done.
Moving forward, Mellors adds that he and his team will try to determine the types of cells that carry HIV in this fluid, whether HIV is infectious and “teasing apart” this apparent relationship between infected cells and this cognitive dysfunction.
If you have HIV and are reading this and feel concerned about your own cognition, what should you do?
As always, Mulligan says to consult your doctor. This is important, because while some brain issues are due to HIV itself, there are many other brain conditions and infections that can affect people who have HIV.
“So, an HIV specialist doctor should do a prompt assessment,” Mulligan said. “The doctor would likely take a medical history, perform a physical exam, order blood tests, and possibly order imaging studies of the brain, and sometimes perform a spinal tap to run tests on cerebrospinal fluid.”
New research out of the University of Pittsburgh found that even after years of effective treatment, some people with HIV had viral cells living in their cerebrospinal fluid.
Out of 69 people, about half had HIV in this spinal fluid. About 30 percent of these people showed signs of cognitive decline.
The researchers caution there’s no proof HIV clearly causes this cognitive impairment. But some people with the virus have been shown to experience problems with memory and concentration.
More needs to be learned. Experts urge people to speak with their doctor if they’re concerned about their own cognition. Beyond HIV, it could be a sign that you have a separate, related brain infection.