Adherence to HIV Treatment May Protect Brain From Further Injury Interview with:

Ryan Sanford

Ryan Sanford

Ryan Sanford, MEng
Department of Neurology and Neurosurgery
Montreal Neurological Institute
McGill University, Montréal, Québec, Canada What is the background for this study? What are the main findings?

Response: With the introduction of combination antiretroviral therapy (cART) the outlook for HIV+ individuals has dramatically shifted from a fatal disease to a chronic manageable condition. However, HIV-associated neurocognitive disorders are still prevalent. The etiology of this dysfunction remains unknown. Previous work has reported progressive brain atrophy in HIV+ individuals with advanced disease and poor viral suppression, but it is unclear whether stable treatment and effective viral suppression can mitigate the progression of brain atrophy. To examine this issue, we followed well-treated HIV+ individuals with good viral suppression and well-matched controls, and assessed whether ongoing brain atrophy occurs over time.

The main finding in this study was the HIV+ participants had reduced brain volumes and poorer cognitive performance compared to the control group, but the changes in brain volumes and cognitive performance were similar between the groups. What should readers take away from your report?

Response: Our results send the hopeful message to chronic HIV+ individuals that adhering to treatment, and maintaining viral suppression may protect the brain from further injury. It also makes the neurological case for early treatment. Finally, it helps to focus the search for possible mechanisms of brain injury in this condition, pointing away from an active, destructive process, and opening the door to novel treatments focused on remediation of the effects of relatively static brain injury. What recommendations do you have for future research as a result of this study?

Response: We demonstrated that the HIV+ participants had reduced brain volumes compared to the control group, but we could not determine when these changes occur. We hypothesize that these changes may reflect brain injury that occurred soon after seroconversion, possibly during untreated infection. However, future work must examine primary HIV-infected participants to verify this hypothesis. In addition, future research should evaluate brain volumes and cognitive performance over a longer period of time to clarify whether very subtle progressive effects are present. Is there anything else you would like to add?

Response: No disclosures to report. 

An important to make is with regards to the HIV+ participants. The HIV+ participants did not have any co-morbid conditions (i.e. major psychiatric disorder, active substance abuse or other neurological disorders), limiting the generalizability to HIV+ individuals with similar characteristics. Indeed, HIV+ individuals with some co-morbid condition may be more likely to experience progressive brain atrophy. Thank you for your contribution to the community.


Sanford R, Fellows LK, Ances BM, Collins DL. Association of Brain Structure Changes and Cognitive Function With Combination Antiretroviral Therapy in HIV-Positive Individuals. JAMA Neurol. Published online November 13, 2017. doi:10.1001/jamaneurol.2017.3036

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


[wysija_form id=”1″]






Last Updated on November 17, 2017 by Marie Benz MD FAAD